What Infections Does Tigecycline Treat?
Tigecycline, a glycylcycline antibiotic, targets complicated infections caused by multidrug-resistant bacteria, including those resistant to other tetracyclines. It works by inhibiting bacterial protein synthesis and is FDA-approved for specific intra-abdominal and skin infections in adults and children over 8 years.[1]
Complicated Skin and Skin Structure Infections (cSSSI)
Tigecycline treats cSSSI from Staphylococcus aureus (methicillin-susceptible and resistant strains), Streptococcus pyogenes, Enterococcus faecalis (vancomycin-susceptible), Escherichia coli, Acinetobacter baumannii, and Klebsiella pneumoniae.[1][2] It covers polymicrobial cases common in diabetic foot infections or post-surgical wounds.
Complicated Intra-Abdominal Infections (cIAI)
Effective against cIAI caused by Citrobacter freundii, Enterobacter cloacae, E. coli, K. oxytoca, K. pneumoniae, Enterococcus faecalis (vancomycin-susceptible), Bacteroides fragilis, B. thetaiotaomicron, B. vulgatus, Clostridium species, and Peptostreptococcus species.[1][2] Used when anaerobes or gram-negatives like Pseudomonas are suspected, though not first-line for uncomplicated cases.
Hospital-Acquired and Ventilator-Associated Pneumonia (HAP/VAP)
Approved for HAP/VAP (non-ventilator and ventilator-associated) from S. aureus (methicillin-susceptible only), Haemophilus influenzae, and Klebsiella pneumoniae, excluding P. aeruginosa and Proteus species due to poor activity.[1][3] Often reserved for resistant gram-positive or Acinetobacter cases in ICU settings.
Off-Label and Emerging Uses
Tigecycline shows activity against Acinetobacter baumannii, Stenotrophomonas maltophilia, and some Carbapenem-resistant Enterobacteriaceae (CRE), leading to off-label use in severe infections like bacteremia or osteomyelitis.[3][4] Limited efficacy against Proteus, Providencia, Morganella, and Pseudomonas restricts its scope. Not recommended for urinary tract infections due to low renal excretion.
Key Limitations and Resistance Patterns
Poor against Pseudomonas aeruginosa, Proteus mirabilis, and Providencia species; higher mortality risk in VAP compared to comparators like imipenem.[3] Dosing is IV only (100 mg load, then 50 mg q12h), with FDA warnings for increased mortality in non-approved uses.[1]
[1]: FDA Label for Tygacil (tigecycline)
[2]: Drugs.com - Tigecycline Indications
[3]: IDSA Guidelines on HAP/VAP
[4]: Clinical Infectious Diseases - Tigecycline Review