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Part III: Guidelines for selected antimicrobial use

3.4 Tigecycline

  1. Prototype drug of antibiotic class glycylcyclines derived from minocycline (153).
  2. Indications: MRSA, VRE and other multidrug-resistant organism with in vitro activity, when standard treatment has failed or is contraindicated (e.g. allergy).
  3. As for tetracyclines, this drug is not licensed for use in children.
  4. Poorly active or inactive against the non-fermenters, such as Stenotrophomonas maltophilia, Pseudomonas spp. and CRAB.
  5. Limitation of use
    • Food and Drug Administration (FDA) warnings: Reports showed an increased mortality in patients treated for nosocomial pneumonia, especially ventilator-associated pneumonia, and also complicated skin and skin structure infections, complicated intra-abdominal infections and diabetic foot infections (154).
    • An updated FDA warning has showed a higher mortality risk among patients who received tigecycline compared to other antibacterial drugs. The deaths resulted from worsening infections, complications of infection, or other underlying medical conditions (155).
  6. Dosage:
    • I.V. loading dose of 100 mg, then 50 mg q12h.
    • Given as slow I.V. infusion (30–60 minutes).
    • Reduce maintenance dose (25 mg q12h) for patients with severe liver disease (Child Pugh C).
  7. Side effects similar to tetracycline.
  8. Please consult clinical microbiologist or infectious disease physician for the use of tigecycline.