Tigecycline Should Not Be Used for Pediatric UTI
Tigecycline is not recommended for urinary tract infections in children and should be avoided for this indication. The drug achieves inadequate urinary concentrations and is explicitly not approved for UTI treatment in any age group, with particularly strong warnings against pediatric use 1.
Why Tigecycline is Inappropriate for Pediatric UTI
Poor Urinary Penetration
- Tigecycline achieves low serum and urinary concentrations due to its large volume of distribution, making it unsuitable for UTI treatment regardless of patient age 2
- The drug is specifically not FDA-approved for urinary tract infections 1
Pediatric-Specific Contraindications
- Tigecycline should be avoided in all pediatric patients unless no alternative antibacterial drugs are available 1, 3, 4
- The FDA explicitly states to avoid use in pediatric patients due to observed increased mortality in adult patients treated with tigecycline 1
- Children under 8 years face additional risk of permanent tooth discoloration 2
Mortality Concerns
- Clinical studies demonstrated numerically higher mortality rates in patients treated with tigecycline compared to comparator antibiotics across multiple infection types 2, 5
- In bloodstream infections specifically, mortality reached 86% in tigecycline-treated cases versus 24% in non-bacteremic infections 6
Appropriate Pediatric Dosing (If Absolutely No Alternatives Exist)
If tigecycline must be used for other severe infections (not UTI) when no alternatives exist:
Age-Based Dosing
- Children 8-11 years: 1.2 mg/kg IV every 12 hours (maximum 50 mg per dose) 2, 1
- Children 12-17 years: 50 mg IV every 12 hours 2, 1
- Children 12-18 years: 100 mg loading dose, then 50 mg twice daily 2
- Children <8 years: No established dosing data; use is not recommended 2
Administration Details
- Infuse over 30-60 minutes every 12 hours 1
- Pediatric infectious diseases specialist consultation is mandatory before considering tigecycline in any pediatric patient 3, 4
Preferred Alternatives for Pediatric UTI
For Multidrug-Resistant Organisms
- Fosfomycin: Single 3-gram oral dose for uncomplicated UTI caused by VRE or resistant organisms 2
- Nitrofurantoin: 100 mg orally every 6 hours for uncomplicated UTI due to VRE 2
- High-dose ampicillin: 18-30 grams IV daily in divided doses for VRE UTI (achieves sufficient urinary concentrations despite resistance) 2
- Amoxicillin: 500 mg IV or PO every 8 hours for VRE UTI 2
For Carbapenem-Resistant Enterobacterales (CRE)
- Ceftazidime-avibactam: 2.5 g IV every 8 hours for complicated UTI 2
- Meropenem-vaborbactam: 4 g IV every 8 hours for complicated UTI 2
- Imipenem-cilastatin-relebactam: 1.25 g IV every 6 hours for complicated UTI 2
- Plazomicin: 15 mg/kg IV every 12 hours for complicated UTI 2
- Single-dose aminoglycoside for simple cystitis due to CRE 2
Critical Clinical Pitfalls
Common Prescribing Errors to Avoid
- Never use tigecycline as first-line therapy for UTI - it is not indicated and achieves inadequate urinary levels 2
- Do not assume tigecycline's broad spectrum makes it appropriate for all resistant organisms in all sites 2
- Avoid tigecycline monotherapy for bacteremia - mortality is significantly higher than combination therapy 2, 6
Monitoring Requirements (If Used for Other Indications)
- Monitor prothrombin time (PT) and activated partial thromboplastin time (aPTT) as tigecycline prolongs both 2, 5
- Watch for gastrointestinal adverse effects (nausea, vomiting, diarrhea occur commonly) 2
- Monitor liver function tests for hepatotoxicity 2
- Assess for hypoglycemia and hypoproteinemia 2
When Tigecycline May Have a Role (Not UTI)
- Complicated intra-abdominal infections caused by VRE: 100 mg IV loading dose, then 50 mg IV every 12 hours 2
- Non-bacteremic multidrug-resistant infections when alternatives exhausted (clinical cure rate 74.2% in pediatric case series) 7
- Always use in combination with other active agents for serious infections 4