Tigecycline

Restricted
Restricted

C. diff Risk

Medium

Oral Bioavailability

NA

Approximate Cost

$$$$

Dosing

Adult

100mg IV load on day 1 then 50mg IV q12h

Renal

No adjustment necessary

Hepatic

Severe impairment - Child Pugh C
100mg load on day 1 then 25mg IV daily

Restricted Use

Infectious Diseases consultation required for use, per policy HS1444

General Information

Acceptable Uses

  • FDA-approved for treatment of skin and skin-structure infections and intraabdominal infections.

  • Management of intra-abdominal infections in patients with contraindications to both betalactams and fluoroquinolones.

  • Management of infections due to multidrug resistant Gram-negative organisms including Acinetobacter on a case by case basis.

  • Salvage therapy for MRSA or VRE infections on a case by case basis.

Unacceptable Uses

  • Bacteremia and endocarditis.

  • Tigecycline should not be used to treat pneumonia as unacceptably high failure rates have been reported (see black box warning).

Common Usage

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

Drug Monitoring

Laboratory

  • LFTs weekly

Clinical

  • GI effects

Adverse Effects

Avoid or use with caution in patients with tetracycline reactions

GI side effects very prominent with significant nausea and vomiting

Tetracycline related adverse events: photosensitivity, acute pancreatitis

Rash, abnormal liver enzymes

Major Interactions

Oral contraceptives less effective

Additional Information

Requires Infectious Disease consultation

Documented safety concerns in bacteremia especially. Avoid in bloodstream infection

Pharmacology

Antimicrobial class: Tetracycline derivative

Pregnancy category: D

Average serum half life: 42 hours

Biliary penetration: Therapeutic

Lung penetration: Therapeutic