High dose of tigecycline for extremely resistant Gram-negative pneumonia: yes, we can

Abstract

Few antimicrobials are currently active to treat infections caused by extremely resistant Gram-negative bacilli (ERGNB), which represent a serious global public health concern. Tigecycline, which covers the majority of these ERGNB (with the exception of Pseudomonas aeruginosa), is not currently approved for hospital-acquired pneumonia, and several meta-analyses have suggested an increased risk of death in patients receiving this antibiotic. Other studies suggest that the use of high-dose tigecycline may represent an alternative in daily practice. De Pascale and colleagues report that the clinical cure rate in patients with ventilator-associated pneumonia is significantly higher with a high dose of tigecycline than with the conventional dose, although mortality was unaffected. This high dose is safe; no patients required discontinuation or dose reduction.

Adverse events of high-dose tigecycline in the treatment of ventilator-associated pneumonia due to multidrug-resistant pathogens

“…Potential prognostic factors for 28-day mortality were evaluated by means of univariate analysis (Annex 3). The logistics regression analysis showed that patients with septic shock (OR = 0.33, 95% CI, 0.12–0.92), MODS (OR = 0.26, 95% CI, 0.08–0.83), and higher APACHE II score (OR = 0.89, 95% CI, 0.80–0.98) were of high risk in mortality, which is consistent with related report that the HD of TGC did not increase clinical mortality [ 17 ] (Table 7 ).…”

The role of eosinophils in sepsis and acute respiratory distress syndrome: a scoping review

“… 19 Five studies did not report a difference in eosinophil count between infectious and non-infectious SIRS groups. 22 , 23 , 33 – 35 Nevertheless, these studies are limited by small sample sizes (range 66–185) and cross-sectional study designs.…”

The blind spot in high-dose tigecycline pharmacokinetics in critically ill patients: membrane adsorption during continuous extracorporeal treatment

“…We read with interest the paper by De Pascale and colleagues [ 1 ] and the accompanying editorial [ 2 ] on high-dose tigecycline (TGC) in critically ill patients with severe infections due to multidrug-resistant bacteria. We agree that the currently recommended TGC dose (100 mg loading followed by 50 mg twice daily) may be largely insufficient for treatment of such infections and may promote resistance.…”