Tigecycline (Tygacil)

Tigecycline is a glycylcycline antibiotic (structurally similar to tetracyclines) with a broad-spectrum bactericidal activity against a wide range of Gram + ve and Gram - ve aerobic and anaerobic bacteria. It acts by inhibiting protein translocation in bacteria. Tigecycline is not active against Pseudomonas aeruginosa.The primary route of elimination is biliary excretion of unchanged tigecycline.

Uses
Intra-abdominal infections including peritonitis
Skin and soft tissue infections

Contraindications
Hypersensitivity to tetracycline
Pregnancy and lactating women (permanent tooth discoloration in foetuses)
Children and adolescents under the age of 18 years (permanent tooth discoloration)

Administration
• IV infusion: initial dose of 100 mg, followed by 50 mg 12 hourly, given over 30–60 min, for 5–14 days

Reconstitute the 50-mg vial with either 5 ml sodium chloride 0.9% or 5 ml glucose 5%. For a 100 mg dose, reconstitute using two vials.Then add the reconstituted solution to 100 ml sodium chloride 0.9% or 5 ml glucose 5% and give over 30–60 min
In severe hepatic impairment (Child–Pugh C): initial dose of 100 mg, followed by 25 mg 12 hourly

Adverse effects
Hypersensitivity
Acute pancreatitis
Elevated LFTs
Hyperphosphataemia
Prolonged APPT and PT
Clostridium difficile-associated diarrhoea

Cautions
Severe hepatic impairment (reduce dose)
Concurrent use of warfarin (increased INR)

Renal replacement therapy
No dosage adjustment required