Re-defining tigecycline therapy.
Tigecycline, the first member of the glycylcyclines, has been approved for complicated skin and soft tissue infections (cSSTIs) and complicated intra-abdominal infections (cIAIs). It has a wide range of activity against Gram-positive and Gram-negative bacteria, including anaerobes. Since its approval, the worldwide clinical use of tigecycline has been heterogeneous, either as a monotherapy or as a part of combination therapy, almost exclusively at the standard dosage, in patients with community-acquired (CA) infections as well as health-care associated (HCA) or nosocomial infections (HA), including infections caused by multidrug-resistant (MDR) bacteria. In recent years, issues and warnings of an increased mortality in these heterogeneous patients treated with tigecycline have been raised by meta-analyses and by regulatory agencies. Re-defining tigecycline therapy is a proposal, based on epidemiological, clinical, microbiological and pharmacological considerations, to distinguish patients who may be treated with monotherapy, according to the official indications and dosages, from those treated with combination treatment, mostly with high dosages in the setting of nosocomial IAIs, possibly caused by MDR bacteria or as a carbapenem-sparing strategy. Whilst available clinical data and guidelines suggest caution with monotherapy in severe infections, experience worldwide indicates that combination treatment with high-dosage tigecycline is increasingly used.
Department of Medical Sciences, University of Turin, Infectious Diseases at Amedeo di Savoia Hospital, Italy.
Francesco G
FG
De Rosa
Department of Medical Sciences, University of Turin, Infectious Diseases at Amedeo di Savoia Hospital, Italy.
Silvia
S
Corcione
Department of Medical Sciences, University of Turin, Infectious Diseases at Amedeo di Savoia Hospital, Italy.
Giovanni
G
Di Perri
Department of Biotechnology and Translational Medicine, University of Milan, Italy.
Francesco
F
Scaglione
D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D008911:Minocycline / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D000078304:Tigecycline
D000900:Anti-Bacterial Agents; D000078304:Tigecycline; D008911:Minocycline
Broad-spectrum antibacterial therapy; Complicated intra-abdominal infections; Complicated skin and soft tissue infections; Glycylcyclines; Tigecycline,