Tigecycline use in the outpatient parenteral antibiotic therapy setting.
In the context of globally increasing antimicrobial resistance, tigecycline appears to be a useful therapeutic option. The need for prolonged courses for complex infections has prompted consideration of its use via outpatient parenteral antibiotic therapy (OPAT) programmes, although clinical outcomes when used in this setting remain unknown. We retrospectively reviewed the patient characteristics and outcomes of 11 patients who received tigecycline, most commonly delivered as 100 mg once daily, via OPAT at three tertiary Australian hospitals. Rates of co-morbidity and prior antibiotic use were high. Patients had a wide range of infections including bone and/or joint (n = 5), intra-abdominal (n = 3), lower respiratory tract (n = 2) and parapharyngeal abscess (n = 1). Mycobacterial species (n = 5) were the most frequent pathogen, and multi-resistant organisms were common (n = 4). The median OPAT duration was 14 days (IQR 6-30). Nausea was encountered in 45 % of cases. At completion of OPAT, 1 patient (9 %) was cured, 2 (18 %) had improved and 8 (73 %) failed therapy. Failure occurred due to either progression or non-response of infection (n = 4), re-admission (n = 3), premature cessation of tigecycline due to nausea (n = 3) or death (n = 1). Whilst OPAT delivery of tigecycline is a therapeutic option, when used as second-line therapy for complex, often multi-resistant infections in patients with multiple comorbidities, high rates of clinical failure, readmissions and adverse effects, especially nausea, should be anticipated.
School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia. paul.ingram@health.wa.gov.au.|Department of Infectious Diseases and Microbiology, Royal Perth Hospital, Perth, WA, Australia. paul.ingram@health.wa.gov.au.
P R
PR
Ingram
Pharmacy Department, Fiona Stanley Hospital, Perth, WA, Australia.
M D M
MD
Rawlins
School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia.|Department of Infectious Diseases, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, WA, Australia.|Department of Microbiology, PathWest Laboratory Medicine WA Queen Elizabeth II Medical Centre, Perth, WA, Australia.
R J
RJ
Murray
Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.|School of Pharmacy, The University of Queensland, Brisbane, Australia.
J A
JA
Roberts
School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.|Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia.
L
L
Manning
D061605:Administration, Intravenous; D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000188:drug therapy*; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage / Q000031:analogs & derivatives*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D000078304:Tigecycline; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000078304:Tigecycline; D008911:Minocycline