Antimicrobials
Tigecycline

Tigecycline

Medium
N/A
See below under General Info

Spectrum of Activity

Dosing

General Information

Hospital Formulary Status Yes (parenteral inj)

In-Hospital Cost will be updated

PharmaCare Formulary Status No

Special Authority None

PharmaCare Coverage None

Outpatient Cost 50mg powder for soln/inj - $77.14-84.85/vial

Reserved for highly resistant infections or when significant allergies restrict other options and when there is documented susceptibility.

Associated with more treatment failures than alternatives and excess mortality - Black Box Warning.

Gastritis (IV)

  • sx: abdominal discomfort, epigastric pain, nausea, vomiting, anorexia, esophageal ulcerations and strictures
  • may alter gut flora to cause large bulky stools and diarrhea, which usually subsides after discontinuation
  • patient with continued diarrhea, fever, and rising WBC count should be evaluated for antibiotic-associated diarrhea caused by C. Difficile
  • more risk than PO tetracyclines

Allergic skin reactions (IV)

  • uncommon: hypersensitivity and photosensitivity reactions (red rash or blistering on areas exposed to the sun)
  • if patient is allergic to one tetracycline, they should be considered allergic to all
  • advise patient to avoid direct sunlight or wearing protective clothing and sunscreen

Teeth and bone toxicity (IV)

  • can cause brown to yellow teeth discoloration in children < 8 years old, which is associated with hypoplasia of enamel
  • discoloration on permanent teeth is dose-related and does not occur in adults
  • may deposit in bone due to chelate formation with calcium
  • avoid in children < 8 years old, but if tetracyclines must be used, doxycycline may be preferred

Hepatotoxicity (IV)

  • rare but can be fatal
  • abnormal liver function tests (increased total bilirubin, prothrombin time and transaminases)
  • closely monitor for worsening hepatic function in patients who develop abnormal liver function tests during therapy
  • hepatic dysfunction and hepatic failure are rare
  • may occur after drug discontinuation

Renal failure exacerbation (IV)

  • tetracyclines inhibit protein synthesis
  • may exacerbate preexisting renal failure by increasing azotemia from amino acid metabolism

Jarisch-Herxheimer type reaction (IV)

  • can occur in patients with spirochetal infections (syphilis, tick-borne relapsing fever and louse-borne relapsing fever)
  • sx: fever, chills, headache, malaise, muscle aches, leukocytosis and exacerbation of cutaneous lesions
  • prevention: use of tumor necrosis factor antibodies and steroids
  • pretreatment: acetaminophen or meptazinol may reduce the symptoms and duration

Mortality (IV)

  • associated with increased mortality when compared with other antibacterial drugs
  • can occur in patients with CAP, HAP, complicated skin and skin structure infections and complicated intra-abdominal infections
  • should be reserved for use in situations when alternative agents are not suitable

Other uncommon ADRs

  • hemolytic anemia
  • thrombocytopenia
  • neutropenia
  • eosinophilia
  • pericardial effusions
  • acute pancreatitis

Oral contraceptives less effective.

Antimicrobial class: Tetracycline Derivative

Pregnancy category: D

Requires Infectious Disease consultation.

Documented safety concerns in bacteremia especially.

Average serum half life: 42.0 hr

Lung penetration: Therapeutic

Biliary penetration: Therapeutic