Recommendations (Infectious Diseases Society of America, IDSA/American Thoracic Society, ATS 2016 Clinical Practice Guidelines for the Management of HAP/VAP (Clin Infect Dis, 2016) [MEDLINE]
Not Recommended for Use in VAP: due to lower clinical cure rates
Pharmacology
Glycylcycline Antibiotic
Structural similarity with tetracyclines (see Tetracyclines, [[Tetracyclines]]): tigecycline is a derivative of minocycline and may share some tetracycline-associated class adverse effects
Mechanism: binds to 30s bacterial ribosomal subunit, inhibiting protein synthesis
Bacteriostatic: in most cases
Bacteriocidal: in some cases (certain isolates of Streptococcus Pneumoniae and Legionella Pneumophila)
Metabolism
Hepatic: via glucuronidation, N-acetylation, and epimerization
Increased Blood Urea Nitrogen (BUN): occurs in 3% of cases
Other Adverse Effects
Increased All-Cause Mortality (of Unclear Etiology): reported in phase 3 and 4 trials
Thrombophlebitis: occurs in 3% of cases
References
Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016 Sep 1;63(5):e61-e111. doi: 10.1093/cid/ciw353. Epub 2016 Jul 14 [MEDLINE]