Tigecycline in treatment of multidrug-resistant Gram-negative bacillus urinary tract infections: a systematic review

Abstract

The clinical efficacy of tigecycline for treatment of UTIs has not been extensively evaluated. Based on the available literature, tigecycline appears to have efficacy in some patients with MDR Gram-negative bacillus UTIs. Further research in this area is needed to fully elucidate the role of tigecycline in treating such patients.

Treatment options for infections caused by carbapenem-resistantEnterobacteriaceae: can we apply “precision medicine” to antimicrobial chemotherapy?

“…The administration of high doses of tigecycline appeared to be well tolerated and was an independent predictor of cure in patients with VAP, supporting the theory that suboptimal dosing in this group of patients could contribute to the increased mortality associated with tigecycline. Although tigecycline achieves low penetration in the urine, some have advocated its use in high doses for the treatment of urinary tract infection (UTI) [108]. In practice, the use of tigecycline to treat CRE (especially KPC-producing K. pneumoniae ) UTI is common, but may be associated with the development of resistance [109,110].…”

Assessment of Tigecycline Prescription and Patients’ Outcomes at Three Different Hospitals in Saudi Arabia

“…This renders tigecycline effective against a wide range of gram-positive and gram-negative organisms, notably highly resistant pathogens such as methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, vancomycinresistant Enterococcus species, extended spectrum β-lactamase producers (ESBL), Clostridium difficile and many carbapenemaseproducing Enterobacteriaceae; however, it has no activity against Proteus or Pseudomonas species [10,11]. It exhibits a linear pharmacokinetic profile, a large volume of distribution Vd (7 10 L), a half-life of 37 -67 h, and clearance of 0.2 -0.3 L/h/kg [12,13].…”

Tigecycline dosing is critical in preventing tigecycline resistance because relative resistance is, in part, concentration dependent

“…van Duin and colleagues article regarding tigecycline 5 resistance following tigecycline therapy for carbapenem resistant K. pneumoniae (CRKP) 6 bacteriuria which has important implications and deserves comment [1]. 7 Their study described resistance following tigecycline therapy in bacteriuric patients, 8 most of which had indwelling urinary catheters, i.e., catheter associated bacteriuria (CAB) [1].…”

“…Before tigecycline is considered, other renally 78 eliminated antibiotics, e.g., nitrofurantoin, fosfomycin should be tried. If therapy is not optional 79 and the GNB MDRO uropathogen is not susceptible to other antibiotics, then tigecycline may be 80 considered [5]. In this setting, we use high dose tigecycline for optimal clinical effectiveness 81 which minimizes the emergence of resistance.…”