Tigecycline is a broad-spectrum glycylcycline antibiotic, structurally derived from minocycline. It is a bacteriostatic agent with activity against a wide range of Gram-positive, Gram-negative, anaerobic, and atypical bacteria, including many multidrug-resistant (MDR) pathogens. It is a critical reserve antibiotic in the Indian context, used primarily for complicated intra-abdominal infections (cIAI) and complicated skin and skin structure infections (cSSSI) when other alternatives are unsuitable due to resistance or allergy.
Adult: Initial dose: 100 mg IV single dose, followed by 50 mg IV every 12 hours. Duration: 5 to 14 days based on infection severity and clinical response.
Note: Reconstitute 50 mg vial with 5.3 mL of 0.9% Sodium Chloride or 5% Dextrose to get 10 mg/mL. Further dilute in 100 mL of compatible IV fluid (NS or D5W). Infuse over 30 to 60 minutes. Flush line before/after with same diluent. Incompatible with amphotericin B, chlorpromazine, methylprednisolone, voriconazole.
Tigecycline inhibits protein synthesis in bacteria by binding reversibly to the 30S ribosomal subunit. This blocks the entry of amino-acyl tRNA molecules into the A site of the ribosome, preventing the incorporation of amino acid residues into elongating peptide chains.
Pregnancy: Category D. May cause fetal harm (retardation of skeletal development). Avoid use in pregnancy unless potential benefit justifies potential risk.
Driving: May cause dizziness; patients should be cautioned about driving or operating machinery.
| Warfarin | Tigecycline may prolong PT/INR; increased monitoring required. | Moderate |
| Oral Contraceptives | Potential reduction in contraceptive efficacy; advise alternative non-hormonal methods. | Moderate |
| Proton Pump Inhibitors (e.g., Omeprazole) | Concurrent use may reduce tigecycline absorption if given orally (not relevant for IV). | Minor |
| Live Bacterial Vaccines (e.g., Typhoid, BCG) | Antibiotics may diminish therapeutic effect of live vaccines. | Moderate |