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Tetracyclines
Published in Thomas T. Yoshikawa, Shobita Rajagopalan, Antibiotic Therapy for Geriatric Patients, 2005
In limited efficacy/tolerability data presented to date, nausea and vomiting have been the major adverse events associated with tigecycline therapy. These events appear to be dose related and can be dose limiting. Administering the drug in the fed state may ameliorate these effects (2).
Tigecycline
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Complicated skin and skin structure infections (cSSSIs) are often caused by multiresistant pathogens and occur in high risk patients, such as those with poor vascular perfusion, pressure sores, and immune suppression (Raghavan and Linden, 2004; Zhanel et al., 2006). The efficacy of tigecycline (100 mg initial dose then 50 mg twice daily for 14 days) was compared with that of vancomycin/aztreonam (1 g i.v. twice daily/2 g i.v. twice daily for 14 days) in hospitalized patients; 833 patients were clinically evaluable (Breedt et al., 2005; Ellis-Grosse et al., 2005). The most prevalent pathogens were S. aureus (MSSA and MRSA), S. pyogenes, and E. coli. Overall clinical cure rates were similar—86.5% for tigecycline, 88.6% for vancomycin/aztreonam (p < 0.01, for noninferiority)—as were the microbiological responses (86% vs. 88%, respectively). There were no differences in clinical cure rates between patients who were and were not bacteremic (82.6% vs. 87.5%). Tigecycline was equally effective in patients who had monomicrobial and polymicrobial infections (86.3% and 86.4%, respectively). There were no differences in MIC50/MIC90 values between methicillin-sensitive and methicillinresistant S. aureus (MSSA and MRSA) (0.12/0.25 mg/l for both). Only cases with vancomycin-susceptible enterococci strains were included; thus, additional clinical studies of vancomycin-resistant enterococci are needed. No isolates acquired reduced susceptibility to tigecycline in this study. The authors concluded that tigecycline is noninferior, and is effective monotherapy for the treatment of cSSSIs.
Analysis of the clinical characteristics of tigecycline-induced hypofibrinogenemia
Published in Journal of Chemotherapy, 2023
Haibo Lei, Xiang Liu, Zuojun Li, Chunjiang Wang
Details for 20 patients (16 males and 4 females) from 18 publications are summarized in Table 1. These people were mainly from Asia (15 patients) and Europe (5 patients). Tigecycline was mainly used for pulmonary infections, bone and joint infections and bacteremia caused by MDR gram-negative bacteria. The median age at onset was approximately 63.5 years (range 39∼90 years). Twelve patients (60.00%) received a loading dose of tigecycline (100∼200 mg), and 11 patients (64.71%) received a maintenance dose of 50 mg q12h, which was followed by 100 mg q12h in 5 patients (29.41%). The median tigecycline treatment duration was 14 days (range 3∼39 days), and the median time of hypofibrinogenemia was 9 days (range 2∼35 days). Four patients (23.52%) had liver damage, and fourteen patients (77.78%) had chronic renal insufficiency before tigecycline treatment. Ten patients (50.00%) took some drugs that affected blood coagulation at the same time.
Intraventricular treatment of paediatric meningitis due to extensively drug-resistant Gram-negative bacteria: two case reports and review of the literature
Published in Journal of Chemotherapy, 2021
Melis Deniz, Anıl Tapısız, Alp Özgün Börcek, Hasan Tezer
The synergistic effect of the combined use of colistin with other antibiotics (such as meropenem and rifampicin) has been demonstrated in in vitro studies. Although the clinical data on the use of combined therapy in newborns and children is inadequate, theoretically, the use of combined antimicrobial therapy in patients with drug resistant GNB infections may be beneficial in achieving maximum bacterial death and preventing resistance.18 Combination therapy may be considered, especially when the MIC value of the microorganisms is more than 2 μg/ml. Rifampicin has an optimal CNS penetration feature and the combination of colistin and rifampicin has a synergistic effect for the treatment of carbapenem-resistant infections.21 In our cases, rifampicin was initiated to optimise the treatment of meningitis and to prevent the growth of colistin-resistant strains. Tigecycline has a broad spectrum of antibacterial activity, however it is not approved for CNS infections in children. Despite this, it may be considered as a rescue therapy in children with life-threatening nosocomial infections.31 Although there are case reports in the literature of patients that have been cured with tigecycline, CSF sterilisation was not achieved in our case despite tigecycline treatment.
Antimicrobial prescribing for treatment of serious infections caused by Staphylococcus aureus and methicillin-resistant Staphylococcus aureus in pediatrics: an expert review
Published in Expert Review of Anti-infective Therapy, 2021
Sean N. Avedissian, Nathanial J. Rhodes, Christopher L. Shaffer, Lan Tran, John S. Bradley, Jennifer Le
As studies evaluating tigecycline in pediatrics are limited, its usage in severe infections caused by S. aureus or MRSA is lacking. Only one clinical trial (phase 2: clinicaltrials.gov # NCT00488345) was requested by FDA and performed by the sponsor due to the risk of tetracycline-associated adverse events in children; this trial assessed tigecycline pharmacokinetics, safety and efficacy in community-acquired pneumonia, complicated intra-abdominal infection, or complicated skin and skin structure infections in children aged 8 to 11 [52]. However, this trial was not specific to S. aureus. The study found that a dose of 1.2 mg/kg q12h may be appropriate for usage in children aged 8 to 11 years with selected serious bacterial infections using PK simulations [52]. Currently, tigecycline is not routinely used in patients under 18 years of age because many other antibiotics with better safety profiles are available for the treatment of MRSA [51]. Its role in therapy should be reserved for situations where no other alternative agents are viable.