Tigecycline: clinical evidence and formulary positioning.
Tigecycline, is a novel broad-spectrum glycylcycline antibiotic, which has activity against a broad range of Gram-positive, Gram-negative, atypical, anaerobic and antibiotic-resistant bacteria. This includes activity against MRSA, VRE and penicillin resistant Streptococcus pneumoniae. Whilst exhibiting antibacterial activities typical of earlier tetracyclines, it has more potent activity against tetracycline-resistant organisms. Although a bacteriostatic compound in vitro, its effectiveness in clinical trials suggests that traditional laboratory thinking about using bacteriostatic drugs in serious infections needs to be revised. Unlike existing tetracyclines, tigecycline is only available as an intravenous preparation, is administered twice daily although its long half life and post-antibiotic effect may make once daily dosing possible, appears to have good tissue penetration (e.g. skin) and requires no adjustment in the presence of renal or hepatic diseases. It is efficacious in complicated skin and soft tissue infections and in intra-abdominal infections. In three trials, it was well tolerated despite increased frequency of nausea and vomiting. In the light of these early clinical data and the likelihood that this agent will become available for clinical use within the next 12-24 months, this review aims to summarise the key clinical data and potential formulary considerations for the future use of this agent, subject to further clinical trials and publication of clinical human data.
Nathwani
Dilip
D
Infection and Immunodeficiency Unit (Ward 42), East Block, Ninewells Hospital and Medical School, Tayside University Hospitals, Dundee DD1 9SY, UK. dilip.nathwani@tuht.scot.nhs.uk
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D024881:Drug Resistance, Bacterial; D005569:Formularies as Topic; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006094:Gram-Positive Bacteria / Q000187:drug effects*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D008911:Minocycline / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D000078304:Tigecycline
D000900:Anti-Bacterial Agents; D000078304:Tigecycline; D008911:Minocycline