tigecycline (Tygacil)
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Introduction
Tradename: Tygacil (expensive broad spectrum antibiotic)
Indications
- bacterial infections due to susceptible organisms
- complicated intra-abdominal infections
- complicated skin infections, including MRSA
- hospitalized patients with community-acquired pneumonia
- refractory C-difficile colitis ?[4]
Contraindications
* should be used only when other treatments are not available
Dosage
- IV infusion over 30-60 minutes
- 100 mg loading dose, then
- 50 mg every 12 hours for 5-14 days
Injection: 10 mg/mL
Dosage adjustment with heptatic insufficiency
- Child-Pugh class 3, decrease to 25 mg every 12 hours
Antimicrobial activity
- many, including MRSA (skin) Staphylococcus, Streptococcus, Enterococcus faecalis
Gram-negative organisms
- Citrobacter, Escherichia, Klebsiella, Enterobacter
- Haemophilus influenza
- Legionella pneumophila
- Acinetobacter baumannii
- NOT very effective against Pseudomonas
Adverse effects
- nausea/vomiting, diarrhea, abdominal pain
- fever, headache, hypertension
- thrombocythemia, anemia
- hypoproteinemia
- increase mortality when used to treat
- hospital-acquired pneumonia, especially ventilator associated pneumonia
- complicated skin infections
- complicated intra-abdominal infections
- diabetic foot infections[5][6]
- increased risk of death when used for FDA-approved uses as well as for non-approved uses[8]
* Black box warning for increased risk of death; use only when alternatives are not available[7]
Drug interactions
- decreased effectiveness of oral contraceptives
- monitor PT with warfarin[2] Interactions:
- increased serum transaminases
- increased serum lactate dehydrogenase
- drug interaction(s) anticonvulsants with anti-bacterial agents
- drug interaction(s) of antibiotics with warfarin
Mechanism of action
- similar to tetracyclines, glycylcycline antibiotic
- inhibits protein translation in bacteria by binding to the bacterial 30S ribosomal subunit
- not affected by 2 major tetracycline resistance mechanisms
More general terms
References
- ↑ Prescriber's Letter 12(7): 2005 New Drug: Tygacil (Tigecycline) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210711&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 2.0 2.1 PDR Monthly Prescribing Guide, August 2005, pg 11
- ↑ Prescriber's Letter 16(7): 2009 Tigecycline (Tygacil) for Community-Acquired Pneumonia (CAP) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=250521&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 4.0 4.1 Herpers BL et al Intravenous tigecycline as adjunctive or alternative therapy for severe refractory Clostridium difficile infection. Clin Infect Dis 2009 Jun 15; 48:1732. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19435431
- ↑ 5.0 5.1 FDA MedWatch Tygacil (tigecycline): Label Change - Increased Mortality Risk Posted 09/01/2010 http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm224626.htm
- ↑ 6.0 6.1 Prasad P et al. Excess deaths associated with tigecycline after approval based on noninferiority trials. Clin Infect Dis 2012 Jun 15; 54:1699 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22467668
Powers JH. Asking the right questions: Morbidity, mortality, and measuring what's important in unbiased evaluations of antimicrobials. Clin Infect Dis 2012 Jun 15; 54:1710. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22467671 - ↑ 7.0 7.1 7.2 Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015
- ↑ 8.0 8.1 FDA MedWatch. September 27, 2013 Tygacil (tigecycline): Drug Safety Communication - Increased Risk of Death. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm370170.htm
- ↑ 9.0 9.1 Deprecated Reference
- ↑ Bai XR, Jiang DC, Yan SY. High-Dose Tigecycline in Elderly Patients with Pneumonia Due to Multidrug-Resistant Acinetobacter baumannii in Intensive Care Unit. Infect Drug Resist. 2020;13:1447-1454. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32547113 Free PMC article