What it's for (Indications)
- Tigecycline is indicated for the treatment of complicated intra-abdominal infections (cIAI), complicated skin and skin structure infections (cSSSI), and community-acquired bacterial pneumonia (CAP).
Dosage Information
| Type | Guideline |
|---|---|
| Standard | The recommended adult dosage is an initial intravenous dose of 100 mg, followed by 50 mg every 12 hours. Infusions should be administered over approximately 30 to 60 minutes. For patients with severe hepatic impairment (Child-Pugh C), the initial dose is 100 mg, followed by 25 mg every 12 hours. The recommended duration of treatment is typically 5 to 14 days for complicated skin and skin structure infections or complicated intra-abdominal infections, and 7 to 14 days for community-acquired bacterial pneumonia. The total duration should be guided by the severity and site of the infection and the patient’s clinical and bacteriological progress. |
Safety & Warnings
Common Side Effects
- Common side effects include gastrointestinal disturbances (e.
- g.
- , nausea, vomiting, diarrhea, abdominal pain), headache, anorexia (loss of appetite), itching, rash, abscess, infections, increased liver function tests (LFTs/SGPT), impaired healing, hypoglycemia (extremely low blood sugar levels), and dizziness.
Serious Warnings
- Black Box Warning: WARNING: ALL-CAUSE MORTALITY. An increase in all-cause mortality has been observed in a meta-analysis of Phase 3 and 4 clinical trials in tigecycline-treated patients versus comparator. The cause of this mortality risk difference of 0.6% (95% CI 0.1, 1.2) has not been established. Tigecycline should be reserved for use in situations when alternative treatments are not suitable.
- An increase in all-cause mortality has been observed in tigecycline-treated patients versus comparator, particularly in hospital-acquired pneumonia where lower cure rates and mortality imbalance were noted.
- Tigecycline should be reserved for situations when alternative treatments are not suitable.
- Serious adverse reactions include anaphylaxis, hepatic adverse effects (including increased LFTs), and acute pancreatitis; monitor for signs of pancreatitis and withdraw immediately if suspected.
- Exercise caution in patients with severe liver impairment and cholestasis.
- Be extra cautious in patients with severe underlying disease or concurrent bacteremia.
How it Works (Mechanism of Action)
Tigecycline, a first-in-class glycylcycline antibiotic, exerts its bacteriostatic activity by specifically inhibiting bacterial protein synthesis. Structurally derived from tetracyclines, it possesses a modified glycylamido moiety that enhances its ribosomal binding affinity and potency. Tigecycline reversibly binds to the 30S ribosomal subunit of susceptible bacteria. This binding prevents the access of aminoacyl-tRNA molecules to the ribosomal A-site, thereby blocking the incorporation of new amino acids into nascent peptide chains. Consequently, protein elongation is halted, leading to the inhibition of bacterial growth and replication. A key pharmacological advantage of tigecycline lies in its ability to overcome common tetracycline resistance mechanisms, including both ribosomal protection proteins and efflux pumps (e.g., Tet(A)-Tet(K) and Tet(M)-Tet(O) proteins), due to its unique structural modifications and altered binding site on the ribosome. This distinct mechanism contributes to its broad spectrum of activity against many multidrug-resistant Gram-positive, Gram-negative, and anaerobic pathogens.