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# Tigecycline
## Overview
Tigecycline is a glycylcycline antibiotic that binds to the 30S ribosomal subunit, inhibiting bacterial protein synthesis. It has broad-spectrum activity against many Gram-positive, Gram-negative, and anaerobic bacteria, including some resistant organisms.
## 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 treatments are not suitable due to its associated increased mortality risk.*
## Adult Dosing
* **Loading Dose:** 100 mg IV once.
* **Maintenance Dose:** 50 mg IV every 12 hours.
* **Duration of Therapy:** Typically 4 to 14 days, depending on the indication and clinical response.
## Pediatric Dosing
* **cSSSI and cIAI (Age 8 to <12 years):** 1 mg/kg IV every 12 hours. Maximum: 50 mg/dose.
* **cSSSI and cIAI (Age 12 to <18 years):** 100 mg IV loading dose, then 50 mg IV every 12 hours.
* **CABP (Age 12 to <18 years):** 100 mg IV loading dose, then 50 mg IV every 12 hours.
*Dosing for pediatric patients under 8 years old is not established due to increased mortality observed in younger children.*
## Dose Adjustments
* **Hepatic Impairment:**
* **Moderate (Child-Pugh B):** After the initial loading dose, administer 50 mg IV every 24 hours.
* **Severe (Child-Pugh C):** After the initial loading dose, administer 25 mg IV every 24 hours.
* **Renal Impairment:** No dose adjustment is necessary.
## Contraindications
* Hypersensitivity to tigecycline, tetracyclines, or any component of the formulation.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, headache, dizziness.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea (CDAD), fungal superinfections, liver dysfunction, injection site reactions, pancreatitis.
* **Black Box Warning:** Increased all-cause mortality observed in patients treated with tigecycline compared to other antibacterial agents in Phase 3 and 4 clinical trials. Use should be reserved for the treatment of infectious diseases where other antibacterial agents are not suitable.
## Key Drug Interactions
Tigecycline may have a weak interaction with warfarin, potentially increasing INR. Monitor INR closely if used concurrently.
## Monitoring
* Monitor for signs and symptoms of anaphylaxis and hypersensitivity reactions.
* Monitor for diarrhea and abdominal cramping; consider testing for C. difficile if CDAD is suspected.
* Monitor liver function tests, particularly in patients with pre-existing hepatic impairment or receiving tigecycline for prolonged periods.
* Monitor INR if co-administered with warfarin.
## Clinical Pearls
* Due to concerns about increased mortality, tigecycline should be reserved for infections where alternative antibiotics are not viable options.
* Administer by slow IV infusion over 30 to 60 minutes. Avoid rapid infusion to minimize side effects.
* Reconstituted solution is stable for 1 hour at room temperature. Diluted infusion solution is stable for 24 hours at room temperature and 48 hours under refrigeration.
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*This information is intended for healthcare professionals. Please consult the most current prescribing information and institutional protocols for definitive guidance.*
