RT Book, Section
A1 Gruenberg, Katherine
A1 Guglielmo, B. Joseph
A2 Papadakis, Maxine A.
A2 McPhee, Stephen J.
A2 Rabow, Michael W.
A2 McQuaid, Kenneth R.
SR Print(0)
ID 1193122047
T1 Tetracycline Derivatives
T2 Current Medical Diagnosis & Treatment 2023
YR 2023
FD 2023
PB McGraw-Hill Education
PP New York, NY
SN 9781264687343
LK accessmedicine.mhmedical.com/content.aspx?aid=1193122047
RD 2024/04/19
AB Tigecycline,  a  glycylcycline  tetracycline  derivative,  is  available  as  a  parenteral  antibacterial  for  the  treatment  of  nosocomial  infection.  It  is  active  against  most  gram-positive  bacteria,  including  methicillin-resistant  staphylococci,  VRE,  and  many  multidrug-resistant  aerobic  gram-negative  bacilli,  including  Acinetobacter,  Enterobacter,  Citrobacter,  and  ESBL-producing  E  coli  and  Klebsiella.  However,  tigecycline  has  little  to  no  activity  against  Pseudomonas  and  only  modest  activity  versus  Proteus  spp.  In  addition,  tigecycline  demonstrates  excellent  anaerobic  activity  against  B  fragilis  and  gram-positive  anaerobes.  A  loading  dose  of  100  mg  is  administered  intravenously  with  maintenance  at  50  mg  every  12  hours.  The  medication  distributes  into  deep  compartments  with  a  large  volume  of  distribution  and  low  serum  levels.  Considering  the  low  achievable  serum  levels  associated  with  tigecycline,  this  agent  should  not  be  used  in  bacteremic  and  septic  patients.  The  medication  is  primarily  eliminated  via  biliary/fecal  excretion  with  a  half-life  of  30–40  hours.  Dose  adjustment  to  25  mg  every  12  hours  is  recommended  in  Child-Pugh  class  C  liver  disease.  Tigecycline  has  a  similar  adverse  effect  profile  as  the  tetracyclines;  upper  GI  side  effects  are  particularly  common.  While  approved  for  complicated  skin  and  soft  tissue  infection  and  intra-abdominal  infection,  the  spectrum  of  activity  of  tigecycline  has  resulted  in  its  use  in  the  treatment  of  certain  resistant  gram-negative  pathogens,  including  ESBL-producing  organisms.  Tigecycline  has  been  associated  with  increased  mortality  in  ventilator-associated  pneumonia  when  compared  with  imipenem.  Consequently,  its  use  in  sepsis  and  ventilator-associated  pneumonia  is  not  recommended.  Tigecycline  has  a  boxed  warning  highlighting  its  increased  all-cause  mortality.  Tigecycline  is  also  not  indicated  for  treatment  of  diabetic  foot  infection  or  hospital-acquired  pneumonia.