期刊
EXPERT REVIEW OF ANTI-INFECTIVE THERAPY
卷 15, 期 3, 页码 257-267出版社
TAYLOR & FRANCIS LTD
DOI: 10.1080/14787210.2017.1268529
关键词
Relative resistance; resistance breakpoints; low resistance potential; dose dependent susceptibility (DD-S); serious systemic infections; MSSA; MRSA; VSE; VRE; klebsiella pneumoniae; acinetobacter sp; stenotropomonas sp; MDR gram negative bacilli (GNB); XDR gram negative bacilli; CRE; C. difficile; high volume of distribution (V-d); long serum half-life (t1/2); once daily dosing; loading dose; concentration dependent kinetics; post-antibiotic effect (PAE); antibiotic stewardship programs (ASP)
Introduction: Tigecycline has emerged as first line therapy for serious systemic infections due to important pathogens (except P. aeruginosa and Proteus sp.), including multi-drug resistant (MDR) and Gram negative bacilli (GNB), including carbapenem resistant Enterobacteriae. Tigecycline has a low resistance potential,' is protective against C. difficile, and is often the only antibiotic effective against MDR GNB, e.g., Klebsiella sp.Areas covered: Standard dose tigecycline therapy has been used for intra-abdominal infections, complicated skin/skin structure infections (cSSSIs), and CAP. Clinical experience with once daily high dose tigecycline (HDT), i.e., 200 - 400mg (IV) x 1, then 100 - 200mg (IV) q24h, is reviewed. Optimal tigecycline efficacy is dependent on PK/PD based dosing. Suboptimal outcomes have been due to inappropriate use or suboptimal dosing.Expert commentary: Tigecycline's spectrum against nearly all important pathogens (including MSSA/MRSA, VSE/VRE, B. fragilis, C. difficile, MDR and GNB) assures tigecycline a critical place in the antibiotic armamentarium. Dosed optimally, HDT can be a cornerstone of antibiotic stewardship programs in preventing C. difficile, treating MDR GNB pathogens, and in preventing resistance. Properly used and optimally dosed, once daily HDT should be considered preferred therapy for severe systemic infections and those due to MDR GNB pathogens.
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