What is the recommended dose of tigecycline (Tygacil) for treating infections?

Tigecycline Dosing Recommendations

The FDA-approved standard dose is 100 mg IV loading dose followed by 50 mg IV every 12 hours, but for severe infections—particularly pneumonia and bloodstream infections—a high-dose regimen of 200 mg IV loading dose followed by 100 mg IV every 12 hours is strongly recommended to improve clinical outcomes and reduce mortality. 1, 2

Standard Dosing for Approved Indications

• For complicated skin and skin structure infections (cSSSI) and complicated intra-abdominal infections (cIAI): Use 100 mg IV loading dose, then 50 mg IV every 12 hours for 5-14 days 1
• For community-acquired pneumonia (CAP): Use 100 mg IV loading dose, then 50 mg IV every 12 hours for 7-14 days 1
• Infusions should be administered over 30-60 minutes 1

High-Dose Regimen for Severe Infections

For hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and severe bloodstream infections, the high-dose regimen achieves significantly better outcomes:

• Dosing: 200 mg IV loading dose followed by 100 mg IV every 12 hours 2
• Clinical rationale: This regimen achieves 85% cure rates compared to only 69.6% with standard dosing for severe pulmonary infections 2, 3
• Pharmacokinetic justification: Standard dosing produces serum Cmax of only 0.87 mg/L and endothelial lining fluid concentrations of just 0.01-0.02 mg/L, which are insufficient for bloodstream and pulmonary infections 2, 3

Multidrug-Resistant Organism (MDRO) Infections

For carbapenem-resistant Acinetobacter baumannii (CRAB):

• Pneumonia: Tigecycline 100 mg IV loading dose, then 50 mg IV q12h PLUS colistin PLUS sulbactam as triple combination therapy for at least 7 days 4
• Bloodstream infections: Same dosing for 10-14 days 4
• Critical caveat: Tigecycline monotherapy is NOT recommended for pneumonia; combination therapy is essential 4
• Use tigecycline only if MIC ≤2 mg/L 4

For carbapenem-resistant Enterobacterales (CRE):

• Standard dose (100 mg loading, then 50 mg q12h) in combination with polymyxins or meropenem 2
• Monotherapy is not recommended 3

For vancomycin-resistant Enterococci (VRE) with cIAI:

• Standard dose: 100 mg IV loading, then 50 mg IV q12h 2

Special Populations

Hepatic impairment:

• Mild to moderate (Child-Pugh A and B): No dose adjustment needed 1
• Severe (Child-Pugh C): 100 mg loading dose, then REDUCE maintenance to 25 mg IV q12h 1

Renal impairment:

• No dose adjustment required, including patients on continuous renal replacement therapy 2, 1

Pediatric patients (use only when no alternatives exist):

• Ages 8-11 years: 1.2 mg/kg IV q12h (maximum 50 mg per dose) 1
• Ages 12-17 years: 50 mg IV q12h after standard 100 mg loading dose 1

Critical Clinical Caveats

Tigecycline should NEVER be used as monotherapy for bacteremia due to poor serum concentrations and documented treatment failures with standard dosing 2, 3

For severe infections, always consider:

• High-dose regimen (200 mg loading, 100 mg q12h) for pneumonia and serious infections 2
• Combination therapy with another active agent for MDRO infections 4, 3
• MIC values: Standard dosing is only appropriate if MIC ≤1 mg/L for most pathogens 4

Common pitfall: Using standard dosing for HAP/VAP results in suboptimal outcomes due to poor lung penetration; the high-dose regimen is essential for pulmonary infections 2, 3