Tigecycline

Background

• Glycylcycline antibiotic

Spectrum of Activity

• Related to tetracycline and doxycycline, with expanded coverage to include streptococci and Enterobacteriaceae, but without coverage for unusual Gram-negative bacteria or Chlamydia trachomatis
• Does cover Acinetobacter and Stenotrophomonas

Pharmacokinetics and Pharmacodynamics

• Rapidly concentrates in tissue, but poor concentration in urine and lung tissue

Dosing

• Intraabdominal infection: 100 mg IV load followed by 50 mg IV q12h
• Pneumonia: 100 mg IV load followed by 50 mg IV q12h
  • High dosing may be useful in HAP/VAP with 100 mg IV q12h
• Skin and soft tissue infection: 100 mg IV load followed by 50 mg IV q12h

Safety

• Black box warning for increased all-cause mortality (4 vs 3%), likely driven by standard dosing tigecycline in VAP
• Commonly causes nausea, vomiting, and diarrhea
• Also anemia, thrombocytopenia, hepatitis, jaundice, AKI