Tigecycline

General

• Type: Glycylcycline (Tetracyclines)
• Dosage Forms: IV
• Common Trade Names: Tygacil

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

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

• Antibiotics (Main)