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# Tigecycline
## Overview
Tigecycline is a glycylcycline antibiotic with broad-spectrum activity against many Gram-positive, Gram-negative, and anaerobic bacteria, including multidrug-resistant organisms. It is structurally similar to tetracyclines but has improved binding to bacterial ribosomes.
## Primary Indications
* Complicated skin and skin structure infections (cSSSI)
* Complicated intra-abdominal infections (cIAI)
* Community-acquired bacterial pneumonia (CABP)
**Note:** Tigecycline should be reserved for situations where alternative antibacterial agents are not suitable due to resistance or other reasons. Its use has been associated with increased mortality.
## Adult Dosing
* **Complicated skin and skin structure infections (cSSSI):**
* Loading dose: 100 mg IV on day 1.
* Maintenance dose: 50 mg IV every 12 hours for 5 to 14 days.
* **Complicated intra-abdominal infections (cIAI):**
* Loading dose: 100 mg IV on day 1.
* Maintenance dose: 50 mg IV every 12 hours for 7 to 14 days.
* **Community-acquired bacterial pneumonia (CABP):**
* Loading dose: 100 mg IV on day 1.
* Maintenance dose: 50 mg IV every 12 hours for 7 to 14 days.
## Pediatric Dosing
Dosing in pediatric patients has not been well-established and is generally not recommended.
## Dose Adjustments
* **Hepatic impairment:**
* Mild to moderate (Child-Pugh A or B): No initial dose adjustment. After the initial loading dose, the maintenance dose should be reduced to 25 mg IV every 12 hours.
* Severe (Child-Pugh C): No initial dose adjustment. After the initial loading dose, the maintenance dose should be reduced to 25 mg IV every 24 hours.
* **Renal impairment:** No dose adjustment is necessary for renal impairment.
## Contraindications
* Hypersensitivity to tigecycline or any component of the formulation.
* Use in patients with known hypersensitivity to tetracyclines.
## Adverse Effects
* Nausea and vomiting (most common)
* Diarrhea
* Headache
* Anorexia
* Abdominal pain
* Infections (e.g., candidiasis)
* Increased mortality (especially in critically ill patients)
* Hepatotoxicity
* Pancreatitis
* Photosensitivity
* Tooth discoloration in pediatric patients below 8 years of age
## Key Drug Interactions
* **Warfarin:** Tigecycline may increase the INR and prolong the prothrombin time. Monitor INR closely when initiating or discontinuing tigecycline in patients receiving warfarin.
* **Oral contraceptives:** Tigecycline may decrease the efficacy of oral contraceptives. Advise patients to use alternative or additional non-hormonal methods of contraception.
* **Other tetracyclines:** Avoid coadministration with other tetracycline antibiotics due to potential for additive toxicity.
## Monitoring
* Monitor for signs and symptoms of severe adverse reactions, including hypersensitivity, Clostridioides difficile-associated diarrhea, and hepatotoxicity.
* Monitor INR closely in patients receiving warfarin.
* Monitor for signs of fungal or bacterial superinfections.
* Consider hepatic function tests in patients with hepatic impairment.
## Clinical Pearls
* Tigecycline is administered as a continuous infusion over 30 to 60 minutes.
* Reconstituted solutions should be further diluted in 0.9% Sodium Chloride or 5% Dextrose Injection.
* The increased mortality associated with tigecycline use has led to its recommendation as a reserved agent for situations where other treatment options are not viable.
* Due to the risk of tooth discoloration, tigecycline is contraindicated in children younger than 8 years old, except in cases where there are no alternative treatments.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making any treatment decisions.
