Tigecycline use in the outpatient parenteral antibiotic therapy setting

• Published in: European journal of clinical microbiology & infectious diseases Vol. 35; no. 10; pp. 1673 - 1677
• Main Authors: Ingram, P. R., Rawlins, M. D. M., Murray, R. J., Roberts, J. A., Manning, L.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2016; Springer Nature B.V
• Subjects: Abdomen; Abscesses; Administration, Intravenous; Adult; Ambulatory Care - methods; Anti-Bacterial Agents - administration & dosage; Antibiotics; Antimicrobial agents; Bacterial Infections - drug therapy; Biomedical and Life Sciences; Biomedicine; Drug dosages; Drug resistance; Drug Utilization; FDA approval; Female; Hospitals; Humans; Infections; Infectious diseases; Internal Medicine; Male; Medical Microbiology; Middle Aged; Minocycline - administration & dosage; Minocycline - analogs & derivatives; Mycobacterium; Nausea; Original Article; Pathogens; Patients; Pharmacy; Respiratory tract; Retrospective Studies; Tertiary Care Centers; Treatment Outcome; Australia; Western Australia Australia; Vancomycin Resistant Enterococcus; Complex Infection; Premature Cessation; Tigecycline; Outpatient Parenteral Antibiotic Therapy
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-016-2709-6

In the context of globally increasing antimicrobial resistance, tigecycline appears to be a useful therapeutic option. The need for prolonged courses for complex infections has prompted consideration of its use via outpatient parenteral antibiotic therapy (OPAT) programmes, although clinical outcomes when used in this setting remain unknown. We retrospectively reviewed the patient characteristics and outcomes of 11 patients who received tigecycline, most commonly delivered as 100 mg once daily, via OPAT at three tertiary Australian hospitals. Rates of co-morbidity and prior antibiotic use were high. Patients had a wide range of infections including bone and/or joint ( n  = 5), intra-abdominal ( n  = 3), lower respiratory tract ( n  = 2) and parapharyngeal abscess ( n  = 1). Mycobacterial species ( n  = 5) were the most frequent pathogen, and multi-resistant organisms were common ( n  = 4). The median OPAT duration was 14 days (IQR 6–30). Nausea was encountered in 45 % of cases. At completion of OPAT, 1 patient (9 %) was cured, 2 (18 %) had improved and 8 (73 %) failed therapy. Failure occurred due to either progression or non-response of infection ( n  = 4), re-admission ( n  = 3), premature cessation of tigecycline due to nausea ( n  = 3) or death ( n  = 1). Whilst OPAT delivery of tigecycline is a therapeutic option, when used as second-line therapy for complex, often multi-resistant infections in patients with multiple comorbidities, high rates of clinical failure, readmissions and adverse effects, especially nausea, should be anticipated.