Tigecycline

General

Adult Dosing

Intra-Abdominal Infections

  • 50mg IV q12h x5-14 days
    • Start: 100mg IV x1

Skin Infections, complicated

  • 50mg IV q12h x5-14 days
    • Start: 100mg IV x1

Pneumonia, Community acquired

  • 50mg IV q12h for at least 5 days
    • Start 100mg IV x1
    • May D/C after 5 days if afebrile 48-72h

Pediatric Dosing

Intra-abdominal Infections

  • 8-11yo
    • 1.2 mg/kg IV q12h
    • Max: 50 mg/12h
  • 12-17 yo
    • 50mg IV 112h

Skin Infections, complicated

  • 8-11yo
    • 1.2 mg/kg IV q12h
    • Max: 50 mg/12h
  • 12-17 yo
    • 50mg IV 112h

Pneumonia, Community Acquired

  • 8-11yo
    • 1.2 mg/kg IV q12h
    • Max: 50 mg/12h
  • 12-17 yo
    • 50mg IV 112h

Special Populations

  • Drug rating in pregnancy:
  • Lactation risk category: Possibly Unsafe; consider alternatives
  • Renal Dosing
    • Adult: No adjustment
    • Pediatric: No adjustment
  • Hepatic Dosing
    • Adult:
      • Child-Pugh Class C: Decrease maintenance dose 50%
    • Pediatric:
      • Not defined, but may be required. See adult dosing.


Contraindications

  • Allergy to class/drug
  • Pregnancy
  • Age <8 years
  • Hospital-acquired pneumonia
  • Diabetic foot infection
  • Caution:
    • Child bearing potential
    • Hepatic impairment


Adverse Reactions

Serious

  • Tooth discoloration children <8 years old
  • Photosensitivity
  • Hypersensitivity reaction
  • Skin reaction
  • Vasculitis
  • Pericarditis
  • Autoimmune hepatitis
  • Hepatotoxicity
  • Nephrotoxicity
  • Esophagitis/ulcer
  • Pancreatitis
  • Thrombocytopenia
  • Neutropenia
  • Hemolytic anemia
  • Pseudotumor cerebri
  • Bulging fontanelles
  • Jarisch-Herxheimer reaction
  • Fetal harm


Common

  • Headache
  • Nausea
  • Dyspepsia
  • Arthralgia
  • Diarrhea
  • Rash
  • Dysmenorrhea
  • Photosensitivity
  • Vulvovaginal candidiasis
  • Skin discoloration
  • Elevated BUN


Pharmacology

  • Half-life: Unknown
  • Metabolism: Minimal
  • Excretion: Bile/feces - 59%; Urine 33%
  • Mechanism of Action: Bacteriostatic

Antibiotic Sensitivities[1]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G S
Strep. Pneumoniae S
Viridans strep X1
Strep. anginosus gp X1
Enterococcus faecalis S
Enterococcus faecium S
MSSA S
MRSA S
CA-MRSA S
Staph. Epidermidis S
C. jeikeium S
L. monocytogenes S
Gram Negatives N. gonorrhoeae X2
N. meningitidis X1
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp S
E. coli/Klebsiella ESBL+ S
E coli/Klebsiella KPC+ S
Enterobacter sp, AmpC neg S
Enterobacter sp, AmpC pos S
Serratia sp X1
Serratia marcescens S
Salmonella sp S
Shigella sp S
Proteus mirabilis X1
Proteus vulgaris I
Providencia sp. X1
Morganella sp. X1
Citrobacter freundii X1
Citrobacter diversus X1
Citrobacter sp. X1
Aeromonas sp X1
Acinetobacter sp. I
Pseudomonas aeruginosa R
Burkholderia cepacia I
Stenotrophomonas maltophilia S
Yersinia enterocolitica X1
Francisella tularensis X1
Brucella sp. X1
Legionella sp. X2
Pasteurella multocida X1
Haemophilus ducreyi X1
Vibrio vulnificus X1
Misc Chlamydophila sp S
Mycoplasm pneumoniae S
Rickettsia sp X1
Mycobacterium avium R
Anaerobes Actinomyces X1
Bacteroides fragilis S
Prevotella melaninogenica S
Clostridium difficile X1
Clostridium (not difficile) S
Fusobacterium necrophorum S
Peptostreptococcus sp. S

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. Sanford Guide to Antimicrobial Therapy 2014