Tigecycline is an antibiotic reserved for specific and serious bacterial infections that are resistant to other medications or when alternative treatments are unsuitable. It belongs to a class of drugs known as glycylcyclines, which are related to tetracycline antibiotics. This drug works by inhibiting the production of proteins that bacteria need to grow and multiply, effectively stopping the spread of the infection.
What Tigecycline Treats
Tigecycline is approved for treating a narrow range of severe infections in adults. These include complicated skin and skin structure infections (cSSSI), which involve deeper soft tissues or require significant surgical intervention. It is also used for complicated intra-abdominal infections (cIAI), such as appendicitis and abscesses. The third approved use is for community-acquired bacterial pneumonia (CABP), a lung infection contracted outside of a hospital setting.
The use of tigecycline is often reserved for situations where bacteria have developed resistance to other common antibiotics. It has demonstrated effectiveness against challenging pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Its application is carefully considered by healthcare providers and is not indicated for treating diabetic foot infections or certain types of pneumonia acquired in a hospital.
Administration and Dosage
Tigecycline is not available in a pill form and must be administered directly into the bloodstream by a healthcare professional. This intravenous (IV) infusion is administered over a period of 30 to 60 minutes.
The standard dosage for adults begins with an initial loading dose of 100 mg. This larger first dose helps the drug reach an effective concentration in the body rapidly. Following the loading dose, patients receive a maintenance dose of 50 mg every 12 hours. This schedule helps maintain a consistent level of the antibiotic in the bloodstream to inhibit bacterial growth.
The duration of treatment depends on the location and severity of the infection. For complicated skin and intra-abdominal infections, the course of therapy is 5 to 14 days. For community-acquired bacterial pneumonia, the treatment period is 7 to 14 days. A healthcare provider will determine the appropriate length of treatment based on the patient’s clinical response.
Potential Side Effects
The most frequently reported side effects associated with tigecycline are gastrointestinal. Nausea and vomiting are particularly common, often occurring within the first one to two days of starting treatment. In clinical studies, nausea affected about 26% of patients, while vomiting occurred in 18%. Diarrhea, stomach pain, and headache are also commonly experienced.
Tigecycline can lead to other adverse effects. Some patients may experience reactions at the IV injection site, such as pain, swelling, or inflammation. Abnormal results on liver function tests have also been reported, including increases in liver enzymes like AST and ALT. In some instances, patients have developed jaundice, which is a yellowing of the skin or eyes.
Less common but more serious complications can occur. One of these is acute pancreatitis, an inflammation of the pancreas that causes severe upper stomach pain. Another potential issue is photosensitivity, where the skin becomes much more susceptible to sunburn. Patients are advised to avoid direct sunlight and tanning beds while undergoing treatment. The drug can also cause an increase in pressure around the brain, a condition that can lead to severe headaches and vision problems.
Serious Warnings and Considerations
The U.S. Food and Drug Administration (FDA) has placed a black box warning on tigecycline. This warning highlights an observed increase in the risk of death from any cause in patients treated with tigecycline compared to those receiving other antibiotics. This increased risk was identified in clinical trials involving patients with serious infections, and the cause is not definitively established.
Tigecycline should not be used during pregnancy as it can cause harm to a developing fetus. The medication is known to cross the placenta and can lead to permanent discoloration of a baby’s teeth later in life. For this reason, tigecycline is avoided in children under the age of eight, as it can interfere with tooth development and may also affect bone growth.
Certain pre-existing conditions require careful consideration before using this antibiotic. Patients with liver disease may need adjusted dosages or closer monitoring, as the drug is processed by the liver. It can also interact with other medications, such as blood thinners like warfarin, potentially increasing their effects.