Dose optimisation based on pharmacokinetic/pharmacodynamic target of tigecycline. (June 2021)

• Record Type: Journal Article
• Authors: Leng, Bing; Yan, Genquan; Wang, Cuicui; Shen, Chengwu; Zhang, Wen; Wang, Wei
• Is Part Of: Journal of global antimicrobial resistance. Volume 25(2021)
• Page Start: 315
• Page End: 322
• Publication Date: 2021-06
• Subjects: Tigecycline -- Infection -- Pharmacokinetics/pharmacodynamics -- PK/PD -- Non-linear protein binding -- Dose optimisation; Drug resistance -- Periodicals; Drug resistance -- Periodicals; Drug resistance; Periodicals; 616.9041
• DOI: 10.1016/j.jgar.2021.04.006
• Languages: English
• ISSNs: 2213-7165

Abstract

Highlights: Tigecycline at standard doses exerts the anticipated effect for most infections. Infections by multidrug- or pandrug-resistant organisms require combination therapy. Tigecycline has an atypical protein binding characteristic. ABSTRACT: Tigecycline, a new first-in-class glycylcycline antibiotic, has shown promising efficacy against a broad range of micro-organisms. It is widely prescribed for various infections, with most prescriptions being considered for off-label use. However, only a few years after its approval by the US Food and Drug Administration (FDA), tigecycline is suspected of increasing all-cause mortality. Some clinicians have suggested such unfavourable outcomes correlate with inadequate drug exposure at the infection site. The pharmacokinetic/pharmacodynamic (PK/PD) profile of a drug plays an important role in predicting its antibiotic effect, which for tigecycline is determined as the ratio of area under the concentration–time curve (AUC) to minimum inhibitory concentration (MIC). In this study, PK/PD targets based on infection sites, bacterial isolates and patient populations are discussed. Generally, a higher dosage of tigecycline for the treatment of serious infections has been recommended in previous reports. However, the latest finding of tigecycline's atypical protein binding property requires consideration when recommending further use. In addition, combination therapy with other antibiotics provides another option by potentially lowering the MICs of multidrug-resistant bacteria. Graphical abstract: Factors need to be considered for dose optimization of tigecycline. Image, graphical abstract