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Immunometabolic Circuits in Infection for Advancing Host Directed Therapies
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Re-defining tigecycline therapy.

Francesco G De Rosa1, Silvia Corcione1, Giovanni Di Perri1

  • 1Department of Medical Sciences, University of Turin, Infectious Diseases at Amedeo di Savoia Hospital, Italy.

The New Microbiologica
|April 28, 2015
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Summary
This summary is machine-generated.

Tigecycline is approved for serious infections but concerns exist regarding increased mortality. Re-defining its use may improve patient outcomes by distinguishing monotherapy from combination treatments.

Keywords:
Broad-spectrum antibacterial therapyComplicated intra-abdominal infectionsComplicated skin and soft tissue infectionsGlycylcyclinesTigecycline,

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Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Microbiology

Background:

  • Tigecycline, a glycylcycline antibiotic, is approved for complicated skin and soft tissue infections (cSSTIs) and complicated intra-abdominal infections (cIAIs).
  • It exhibits broad-spectrum activity against Gram-positive, Gram-negative, and anaerobic bacteria, including multidrug-resistant (MDR) pathogens.
  • Heterogeneous clinical use, including standard dosage monotherapy and combination therapy for community-acquired and healthcare-associated infections, has been observed worldwide.

Purpose of the Study:

  • To propose a re-definition of tigecycline therapy based on epidemiological, clinical, microbiological, and pharmacological data.
  • To differentiate patient populations suitable for tigecycline monotherapy versus combination treatment.
  • To address concerns regarding increased mortality associated with tigecycline use in certain patient groups.

Main Methods:

  • Review of epidemiological, clinical, microbiological, and pharmacological data.
  • Analysis of meta-analyses and regulatory agency warnings concerning tigecycline-associated mortality.
  • Consideration of current clinical data and guidelines on tigecycline usage.

Main Results:

  • Meta-analyses and regulatory agencies have raised concerns about increased mortality in heterogeneous patient populations treated with tigecycline.
  • A proposal exists to re-define tigecycline therapy, distinguishing between monotherapy and combination treatment.
  • Combination treatment with high-dose tigecycline is increasingly utilized, particularly for nosocomial intra-abdominal infections (IAIs) involving MDR bacteria or as a carbapenem-sparing approach.

Conclusions:

  • Clinical data and guidelines suggest caution with tigecycline monotherapy in severe infections.
  • Worldwide experience indicates a growing trend towards using combination treatment with high-dose tigecycline.
  • Re-evaluating tigecycline therapeutic strategies is crucial for optimizing patient outcomes and safety.