Tigecycline Use in Neonates: 5-Year Experience of a Tertiary Center

Abstract

The off-label use of tigecycline to treat serious infections has been reported in pediatric patients. We report four newborn infants diagnosed with sepsis caused by extensively drug-resistant Klebsiella pneumoniae and successfully treated with tigecycline. If no alternative drugs are available, tigecycline may be considered as an option for nosocomial infections even in newborn infants. However, further reports are needed to establish its efficacy and safety.

Off-Label Use of Ceftazidime-Avibactam in a Premature Infant With Multidrug-Resistant Klebsiella pneumoniae Infection: A Case Report

“…In pediatric patients, tigecycline is not recommended because it can lead to gastrointestinal adverse events (nausea, vomiting, diarrhea, and acute pancreatitis), prolonged coagulation times, mild increase in transaminases, direct bilirubinemia, thrombocytopenia, and permanent discoloration of the teeth, although studies have reported the use of tigecycline combined with other antimicrobial agents in the treatment of MDR infection in newborn infants and children. 17-24…”

“…In pediatric patients, tigecycline is not recommended because it can lead to gastrointestinal adverse events (nausea, vomiting, diarrhea, and acute pancreatitis), prolonged coagulation times, mild increase in transaminases, direct bilirubinemia, thrombocytopenia, and permanent discoloration of the teeth, although studies have reported the use of tigecycline combined with other antimicrobial agents in the treatment of MDR infection in newborn infants and children. [17][18][19][20][21][22][23][24] Thus, CAZ-AVI 50 (40/10) mg/kg IV q8h dosage was initially chosen (dosage for patients aged 3 months to < 6 months); however, after two days, it was adjusted based on renal function to 23.75 mg/kg IV q48h, returning to the initial dose on the fifth day. Our patient was treated with CAZ-AVI for 14 days.…”

Use of Newer and Repurposed Antibiotics against Gram-Negative Bacteria in Neonates

“…The outcome of all patients was favorable without serious adverse events. Interestingly, after the first week of treatment, all neonates presented with thrombocytopenia related to the drug, with PLT gradually returning to normal values after the end of therapy [ 120 ].…”