1
|
Shi S, Xu M, Zhao Y, Feng L, Liu Q, Yao Z, Sun Y, Zhou T, Ye J. Tigecycline-Rifampicin Restrains Resistance Development in Carbapenem-Resistant Klebsiella pneumoniae. ACS Infect Dis 2023; 9:1858-1866. [PMID: 37669401 DOI: 10.1021/acsinfecdis.3c00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
The goal of this study was to clarify the synergistic antibacterial activity of the combination of tigecycline (TGC) and rifampicin (RIF). Additionally, the study sought to investigate the impact of this combination on the development of mutational resistance and to assess its efficacy in an in vivo model using Galleria mellonella. Through a checkerboard test, we found that the combination of TGC and RIF showed synergistic antibacterial activity against carbapenem-resistant Klebsiella pneumoniae (CRKP). The fractional inhibition concentration index (FICI) was found to be ≤0.5, confirming the potency of the combination. Additionally, this synergistic effect was further validated in vivo using the G. mellonella infection model. TGC-RIF treatment had a lower mutant prevention concentration (MPC) than that of monotherapy, indicating its potential to reduce the development of mutational resistance. We observed a substantial variation in the MPCs of TGC and RIF when they were measured at different proportions in the combinations. Furthermore, during the resistant mutant selection window (MSW) test, we noticed a correlation between strains with low FICI and low MSW. The expression of efflux-pump-related genes, namely rarA and acrB, is significantly decreased in the combination therapy group. This indicates that altered expression levels of certain efflux pump regulator genes are associated with a combined decrease in bacterial mutation resistance. In conclusion, the combination of TGC and RIF effectively suppresses antibiotic resistance selection in CRKP. This study establishes a paradigm for evaluating drug-resistant mutant suppression in antimicrobial combination therapy.
Collapse
Affiliation(s)
- Shiyi Shi
- Department of Medical Laboratory Science, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou 325035, People's Republic of China
| | - Mengxin Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou 325000, People's Republic of China
| | - Yining Zhao
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou 325000, People's Republic of China
| | - Luozhu Feng
- Department of Medical Laboratory Science, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou 325035, People's Republic of China
| | - Qi Liu
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou 325000, People's Republic of China
| | - Zhuocheng Yao
- Department of Medical Laboratory Science, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou 325035, People's Republic of China
| | - Yao Sun
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou 325000, People's Republic of China
| | - Tieli Zhou
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou 325000, People's Republic of China
| | - Jianzhong Ye
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou 325000, People's Republic of China
| |
Collapse
|
2
|
Herrera-Hidalgo L, Fernández-Rubio B, Luque-Márquez R, López-Cortés LE, Gil-Navarro MV, de Alarcón A. Treatment of Enterococcus faecalis Infective Endocarditis: A Continuing Challenge. Antibiotics (Basel) 2023; 12:antibiotics12040704. [PMID: 37107066 PMCID: PMC10135260 DOI: 10.3390/antibiotics12040704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/07/2023] Open
Abstract
Today, Enterococcus faecalis is one of the main causes of infective endocarditis in the world, generally affecting an elderly and fragile population, with a high mortality rate. Enterococci are partially resistant to many commonly used antimicrobial agents such as penicillin and ampicillin, as well as high-level resistance to most cephalosporins and sometimes carbapenems, because of low-affinity penicillin-binding proteins, that lead to an unacceptable number of therapeutic failures with monotherapy. For many years, the synergistic combination of penicillins and aminoglycosides has been the cornerstone of treatment, but the emergence of strains with high resistance to aminoglycosides led to the search for new alternatives, like dual beta-lactam therapy. The development of multi-drug resistant strains of Enterococcus faecium is a matter of considerable concern due to its probable spread to E. faecalis and have necessitated the search of new guidelines with the combination of daptomycin, fosfomycin or tigecycline. Some of them have scarce clinical experience and others are still under investigation and will be analyzed in this review. In addition, the need for prolonged treatment (6–8 weeks) to avoid relapses has forced to the consideration of other viable options as outpatient parenteral strategies, long-acting administrations with the new lipoglycopeptides (dalbavancin or oritavancin), and sequential oral treatments, which will also be discussed.
Collapse
Affiliation(s)
- Laura Herrera-Hidalgo
- Unidad de Gestión Clínica de Farmacia, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología (UCEIMP) Grupo de Resistencias Bacterianas y Antimicrobianos (CIBERINFEC), Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain
| | - Beatriz Fernández-Rubio
- Unidad de Gestión Clínica de Farmacia, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Rafael Luque-Márquez
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología (UCEIMP) Grupo de Resistencias Bacterianas y Antimicrobianos (CIBERINFEC), Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain
| | - Luis E. López-Cortés
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Grupo de Resistencias Bacterianas y Antimicrobianos (CIBERINFEC), Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena/SCIC/Universidad de Sevilla, 41009 Seville, Spain
| | - Maria V. Gil-Navarro
- Unidad de Gestión Clínica de Farmacia, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Arístides de Alarcón
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología (UCEIMP) Grupo de Resistencias Bacterianas y Antimicrobianos (CIBERINFEC), Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain
| |
Collapse
|
3
|
Tang HJ, Chen CC, Ko WC. Tigecycline therapy for bacteremia and aortitis caused by Salmonella enterica serotype Choleraesuis: A case report. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2016; 49:131-3. [DOI: 10.1016/j.jmii.2012.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 11/11/2011] [Accepted: 01/16/2012] [Indexed: 10/28/2022]
|
4
|
Efficacy of tigecycline-colistin combination in the treatment of carbapenem-resistant Klebsiella pneumoniae endocarditis. J Glob Antimicrob Resist 2015; 3:214-216. [PMID: 27873712 DOI: 10.1016/j.jgar.2015.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/04/2015] [Accepted: 06/04/2015] [Indexed: 11/20/2022] Open
Abstract
Here we discuss the efficacy of colistin-tigecycline combination in the treatment of multidrug-resistant (MDR) Klebsiella pneumoniae infective endocarditis (IE). We report a case of a 67-year-old head-injured patient who developed a carbapenem-resistant K. pneumoniae IE. The patient was treated with colistin-tigecycline combination, with a favourable outcome. In conclusion, colistin-tigecycline combination may be a possible combination in the therapy of IE caused by MDR Enterobacteriaceae.
Collapse
|
5
|
Effects of various antibiotics alone or in combination with doripenem against Klebsiella pneumoniae strains isolated in an intensive care unit. BIOMED RESEARCH INTERNATIONAL 2014; 2014:397421. [PMID: 25530961 PMCID: PMC4228717 DOI: 10.1155/2014/397421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/01/2014] [Indexed: 11/17/2022]
Abstract
Colistin, tigecycline, levofloxacin, tobramycin, and rifampin alone and in combination with doripenem were investigated for their in vitro activities and postantibiotic effects (PAEs) on Klebsiella pneumoniae. The in vitro activities of tested antibiotics in combination with doripenem were determined using a microbroth checkerboard technique. To determine the PAEs, K. pneumoniae strains in the logarithmic phase of growth were exposed for 1 h to antibiotics, alone and in combination. Recovery periods of test cultures were evaluated using viable counting after centrifugation. Colistin, tobramycin, and levofloxacin produced strong PAEs ranging from 2.71 to 4.23 h, from 1.31 to 3.82 h, and from 1.35 to 4.72, respectively, in a concentration-dependent manner. Tigecycline and rifampin displayed modest PAEs ranging from 1.18 h to 1.55 h and 0.92 to 1.19, respectively. Because it is a beta-lactam, PAEs were not exactly induced by doripenem (ranging from 0.10 to 0.18 h). In combination, doripenem scarcely changed the duration of PAE of each tested antibiotic alone. The findings of this study may have important implications for the timing of doses during K. pneumoniae therapy with tested antibiotics.
Collapse
|
6
|
An optimized mouse thigh infection model for enterococci and its impact on antimicrobial pharmacodynamics. Antimicrob Agents Chemother 2014; 59:233-8. [PMID: 25348523 DOI: 10.1128/aac.02352-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Negligible in vivo growth of enterococci and high-level dispersion of data have led to inaccurate estimations of antibiotic pharmacodynamics (PD). Here we improved an in vivo model apt for PD studies by optimizing the in vitro culture conditions for enterococci. The PD of vancomycin (VAN), ampicillin-sulbactam (SAM), and piperacillin-tazobactam (TZP) against enterococci were determined in vivo, comparing the following different conditions of inoculum preparation: aerobiosis, aerobiosis plus mucin, and anaerobiosis plus mucin. Drug exposure was expressed as the ratio of the area under the concentration-time curve for the free, unbound fraction of the drug to the MIC (fAUC/MIC) (VAN) or the time in a 24-h period that the drug concentration for the free, unbound fraction exceeded the MIC under steady-state pharmacokinetic conditions (fT(>MIC)) (SAM and TZP) and linked to the change in log10 CFU/thigh. Only anaerobiosis plus mucin enhanced the in vivo growth, yielding significant PD parameters with all antibiotics. In conclusion, robust in vivo growth of enterococci was crucial for better determining the PD of tested antibacterial agents, and this was achieved by optimizing the procedure for preparing the inoculum.
Collapse
|
7
|
Pharmacokinetics of intravenously administered tigecycline in eye compartments: an experimental study. Graefes Arch Clin Exp Ophthalmol 2014; 252:1993-7. [PMID: 25150050 DOI: 10.1007/s00417-014-2784-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 08/12/2014] [Accepted: 08/13/2014] [Indexed: 01/15/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the ocular distribution of intravenously administered tigecycline in a rabbit uveitis model. METHODS Tigecycline, which has a broad spectrum of activity against many gram-positive, gram-negative, and anaerobic organisms, was given intravenously to rabbits at 7 mg/kg of body weight starting 24 h after induction of uveitis by intravitreal endotoxin injection. Tigecycline concentrations were determined by high performance liquid chromatography-mass spectrometry (LC-MS/MS) assay in the aqueous humor, vitreous humor, and plasma 1, 3, 6, and 24 h after administration of a single dose. RESULTS The maximum concentrations were found within 1 h after the end of the intravenously given tigecycline, and were 1,308.60 ± 301.76 ng/mL in plasma, 181.40 ± 51.32 ng/mL in vitreous humor and 145.00 ± 55.29 ng/mL in aqueous humor of the inflamed eye. After 24 h, no drug was detectable in the aqueous and vitreous of the normal eyes, whereas small amounts of drug were detectable in inflamed eyes and in plasma. CONCLUSIONS Tigecycline did not reach therapeutically significant levels in the aqueous and the vitreous humor of rabbit eyes. The findings suggest a limited role for intravenously administered tigecycline in the treatment of bacterial endophthalmitis.
Collapse
|
8
|
Abstract
As a consequence of antibiotic overuse and misuse, nosocomial infections caused by multidrug-resistant bacteria represent a physician's nightmare throughout the world. No newer antimicrobials active against Pseudomonas aeruginosa, the main multidrug-resistant nosocomial pathogen, are available or under investigation. The only exceptions are linezolid, some newer glycopeptides (dalbavancin, oritavancin and telavancin) and daptomycin (a lipopeptide), which are active against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) strains, as well as tigecycline, a potent in vitro glycylcycline against MRSA, VRE, Acinetobacter baumannii and entended-spectrum beta-lactamase (ESBL)+ Enterobacteriaceae. Colistin, an antibiotic of the 1950s has been rediscovered by intensive care unit physicians for use against ESBL+ Enterobacteriaceae, as well as against multidrug-resistant P. aeruginosa and A. baumannii isolates. Although success rates with colistin range between 50 and 73%, almost all studies are retrospective. Immunostimulation efforts against S. aureus are still under development. As antibiotic research and development stagnate, rational policies for prescribing existing antibiotics plus strict infection control are the current mainstay efforts for preventing and combating multidrug-resistant bacterial infections.
Collapse
Affiliation(s)
- Helen Giamarellou
- 4th Department of Internal Medicine, University General Hospital ATTIKON, 1 Rimini Street, 124 64 Athens, Greece.
| |
Collapse
|
9
|
Arias CA, Murray BE. Emergence and management of drug-resistant enterococcal infections. Expert Rev Anti Infect Ther 2014; 6:637-55. [DOI: 10.1586/14787210.6.5.637] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
10
|
Zhanel GG, Karlowsky JA, Rubinstein E, Hoban DJ. Tigecycline: a novel glycylcycline antibiotic. Expert Rev Anti Infect Ther 2014; 4:9-25. [PMID: 16441206 DOI: 10.1586/14787210.4.1.9] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tigecycline, the first-in-class glycylcycline, was developed to recapture the broad spectrum of activity of the tetracycline class and to treat patients with difficult-to-treat bacterial infections. Tigecycline's in vitro spectrum of activity encompasses aerobic, facultative and anaerobic Gram-positive and -negative bacteria, including antimicrobial-resistant bacteria such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis and Enterococcus faecium, and extended-spectrum beta-lactamase-producing Enterobacteriaceae. Clinical trials involving patients with complicated skin and skin-structure infections and complicated intra-abdominal infections, including patients infected with methicillin-resistant S. aureus, demonstrated that tigecycline was bacteriologically and clinically effective with mild-to-moderate gastrointestinal adverse events (i.e., nausea, vomiting and diarrhea) the most commonly reported. Tigecycline is a promising new broad-spectrum parenteral monotherapy for the treatment of patients with Gram-positive and -negative bacterial infections.
Collapse
Affiliation(s)
- George G Zhanel
- Department of Medical Microbiology, Faculty of Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
| | | | | | | |
Collapse
|
11
|
Abstract
The pharmacokinetics and pharmacodynamics of tigecycline have been extensively studied in laboratory models and healthy volunteers. Tigecycline is available as a parenteral agent, exhibits linear pharmacokinetics, has a long terminal half-life, is extensively distributed into the tissues and attains steady-state levels in serum by day 7. The pharmacokinetics of tigecycline appear unaffected by age, renal disease and food. Clinical trials have shown that tigecycline (50 mg i.v. q12h) in adults is safe and generally well tolerated for up to 11.5 days. Drug-related adverse events, which are typically mild to moderate in intensity and of limited duration, mainly include nausea and vomiting. Tolerability of tigecycline in fasting subjects is improved by the use of antiemetics. C. difficile-related complications with tigecycline are uncommon. In the majority of patients, tigecycline has minimal adverse effects on blood chemistry or haematology.
Collapse
Affiliation(s)
- J Rello
- Critical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, Institut Pere Virgili, Tarragona, Spain.
| |
Collapse
|
12
|
Efficacy of tigecycline alone and in combination with gentamicin in the treatment of experimental endocarditis due to linezolid-resistant Enterococcus faecium. Antimicrob Agents Chemother 2013; 57:3392-4. [PMID: 23587961 DOI: 10.1128/aac.00646-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We evaluated the efficacy of tigecycline in a rabbit model of experimental endocarditis caused by a linezolid-resistant clinical strain of Enterococcus faecium. Tigecycline-treated animals had a 2.8-log10-CFU/g reduction in microbial counts in excised vegetations compared with controls. Addition of gentamicin caused a further arithmetical reduction in colony counts. The therapeutic effect was sustained 5 days after completion of treatment, as shown by relapse studies performed in treatment groups.
Collapse
|
13
|
High-Level Aminoglycoside-Resistant Enterococcal Endocarditis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2013. [DOI: 10.1097/ipc.0b013e31825aee03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Abstract
Treatment of enterococcal infections has long been recognized as an important clinical challenge, particularly in the setting of infective endocarditis (IE). Furthermore, the increase prevalence of isolates exhibiting multidrug resistance (MDR) to traditional anti-enterococcal antibiotics such as ampicillin, vancomycin and aminoglycosides (high-level resistance) poses immense therapeutic dilemmas in hospitals around the world. Unlike IE caused by most isolates of Enterococcus faecalis, which still retain susceptibility to ampicillin and vancomycin, the emergence and dissemination of a hospital-associated genetic clade of multidrug resistant Enterococcus faecium, markedly limits the therapeutic options. The best treatment of IE MDR enterococcal endocarditis is unknown and the paucity of antibiotics with bactericidal activity against these organisms is a cause of serious concern. Although it appears that we are winning the war against E. faecalis, the battle rages on against isolates of multidrug-resistant E. faecium.
Collapse
Affiliation(s)
- Jose M. Munita
- Laboratory for Antimicrobial Research, University of Texas Medical School at Houston, Houston, TX, USA. Clínica Alemana – Universidad del Desarrollo School of Medicine, Santiago, Chile
| | - Cesar A. Arias
- Department of Internal Medicine, Division of Infectious Diseases, Center for the Study of Emerging and Reemerging Pathogens, Houston, TX, USA. Laboratory for Antimicrobial Research, University of Texas Medical School at Houston, Houston, TX, USA. Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogotá, Colombia. University of Texas Medical School, 6431 Fannin St, Room 2.112 MSB, Houston, TX 77030, USA
| | - Barbara E. Murray
- Department of Internal Medicine, Division of Infectious Diseases, Center for the Study of Emerging and Reemerging Pathogens, Houston, TX, USA. Laboratory of Enterococcal Research, University of Texas Medical School at Houston, Houston, TX, USA. Department of Microbiology and Molecular Genetics, University of Texas Medical School at Houston, Houston, TX, USA. University of Texas Medical School, 6431 Fannin St, Room 2.112 MSB, Houston, TX 77030, USA
| |
Collapse
|
15
|
Efficacy of tigecycline and vancomycin in experimental catheter-related Staphylococcus epidermidis infection: microbiological and electron microscopic analysis of biofilm. Int J Antimicrob Agents 2012; 39:338-42. [DOI: 10.1016/j.ijantimicag.2012.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 11/12/2011] [Accepted: 01/02/2012] [Indexed: 11/21/2022]
|
16
|
Giamarellou H, Poulakou G. Pharmacokinetic and pharmacodynamic evaluation of tigecycline. Expert Opin Drug Metab Toxicol 2011; 7:1459-70. [DOI: 10.1517/17425255.2011.623126] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
17
|
Batard E, Jamme F, Villette S, Jacqueline C, de la Cochetière MF, Caillon J, Réfrégiers M. Diffusion of ofloxacin in the endocarditis vegetation assessed with synchrotron radiation UV fluorescence microspectroscopy. PLoS One 2011; 6:e19440. [PMID: 21559378 PMCID: PMC3084860 DOI: 10.1371/journal.pone.0019440] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 03/28/2011] [Indexed: 11/18/2022] Open
Abstract
The diffusion of antibiotics in endocarditis vegetation bacterial masses has not
been described, although it may influence the efficacy of antibiotic therapy in
endocarditis. The objective of this work was to assess the diffusion of
ofloxacin in experimental endocarditis vegetation bacterial masses using
synchrotron-radiation UV fluorescence microspectroscopy. Streptococcal
endocarditis was induced in 5 rabbits. Three animals received an unique IV
injection of 150 mg/kg ofloxacin, and 2 control rabbits were left untreated. Two
fluorescence microscopes were coupled to a synchrotron beam for excitation at
275 nm. A spectral microscope collected fluorescence spectra between 285 and 550
nm. A second, full field microscope was used with bandpass filters at
510–560 nm. Spectra of ofloxacin-treated vegetations presented higher
fluorescence between 390 and 540 nm than control. Full field imaging showed that
ofloxacin increased fluorescence between 510 and 560 nm. Ofloxacin diffused into
vegetation bacterial masses, although it accumulated in their immediate
neighborhood. Fluorescence images additionally suggested an ofloxacin
concentration gradient between the vegetation peripheral and central areas. In
conclusion, ofloxacin diffuses into vegetation bacterial masses, but it
accumulates in their immediate neighborhood. Synchrotron radiation UV
fluorescence microscopy is a new tool for assessment of antibiotic diffusion in
the endocarditis vegetation bacterial masses.
Collapse
Affiliation(s)
- Eric Batard
- Université de Nantes, EA3826 Thérapeutiques cliniques et expérimentales des infections, Nantes, France.
| | | | | | | | | | | | | |
Collapse
|
18
|
Estes KS, Derendorf H. Comparison of the pharmacokinetic properties of vancomycin, linezolid, tigecyclin, and daptomycin. Eur J Med Res 2010; 15:533-43. [PMID: 21163728 PMCID: PMC3352102 DOI: 10.1186/2047-783x-15-12-533] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 11/22/2010] [Indexed: 11/24/2022] Open
Abstract
The rapid antibiotic resistance development has created a major demand for new antimicrobial agents that can combat resistant strains such as methicillin-resistant S. aureus (MRSA). Until a short time ago, the glycopeptide vancomycin was the only therapeutic choice in this situation. However, in recent years some newer agents with different mechanisms of actions have been added to the arsenal, and more are on the horizon. For a successful therapy it is of vital importance that these compounds are used judiciously and dosed appropriately. The present article reviews the pharmacokinetic properties of vancomycin, linezolid, tigecycline and daptomycin. The first major difference between these compounds is their oral bioavailability. Only linezolid can be administered orally, whereas vancomycin, daptomycin and tigecycline are limited to parenteral use. Once in the body, they show very different disposition. Daptomycin has a very small volume of distribution of 7L indicating very little tissue distribution whereas tigecycline has a very large volume of distribution of 350-500 L. Vancomycin and linezolid are in-between with volumes of distribution of approximately 30 and 50 L, close to total body water. However, studies have shown that linezolid shows better tissue penetration than vancomycin. Newer studies using microdialysis, a new technique that allows direct monitoring of unbound tissue levels, support this finding. As far as drug elimination, daptomycin and vancomycin are mainly eliminated into the urine and require dosing adjustments in renally impaired patients, whereas tigecycline is eliminated into the bile and linezolid is metabolized so that in renal patients no dosing adjustments are needed for these compounds. Although the elimination pathways are very different, the resulting half-lives of linezolid, vancomycin, and daptomycin are not greatly different and vary from 4-8 h. Tigecycline, however, has a much longer half-life of up to 1-2 days due to the slow redistribution from tissue binding sites.
Collapse
Affiliation(s)
| | - Hartmut Derendorf
- Department of Pharmaceutics, University of Florida, Gainesville, FL, USA
| |
Collapse
|
19
|
Devasahayam G, Scheld WM, Hoffman PS. Newer antibacterial drugs for a new century. Expert Opin Investig Drugs 2010; 19:215-34. [PMID: 20053150 DOI: 10.1517/13543780903505092] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE OF THE FIELD Antibacterial drug discovery and development has slowed considerably in recent years, with novel classes discovered decades ago and regulatory approvals tougher to get. Traditional approaches and the newer genomic mining approaches have not yielded novel classes of antibacterial compounds. Instead, improved analogues of existing classes of antibacterial drugs have been developed by improving potency, minimizing resistance and alleviating toxicity. AREAS COVERED IN THIS REVIEW This article is a comprehensive review of newer classes of antibacterial drugs introduced or approved after year 2000. WHAT THE READER WILL GAIN It describes their mechanisms of action/resistance, improved analogues, spectrum of activity and clinical trials. It also discusses new compounds in development with novel mechanisms of action, as well as novel unexploited bacterial targets and strategies that may pave the way for combating drug resistance and emerging pathogens in the twenty-first century. TAKE HOME MESSAGE The outlook of antibacterial drug discovery, though challenging, may not be insurmountable in the years ahead, with legislation on incentives and funding introduced for developing an antimicrobial discovery program and efforts to conserve antibacterial drug use.
Collapse
Affiliation(s)
- Gina Devasahayam
- University of Virginia, Department of Medicine, Room 2146 MR4 Bldg, 409 Lane Rd, Charlottesville, VA 22908, USA.
| | | | | |
Collapse
|
20
|
Parsonage M, Shah S, Moss P, Thaker H, Meigh R, Balaji A, Elston J, Barlow G. Breakthrough bacteraemia with a susceptible Enterococcus faecalis during tigecycline monotherapy. J Antimicrob Chemother 2009; 65:370-4. [PMID: 20022936 DOI: 10.1093/jac/dkp455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mirella Parsonage
- Department of Infection & Tropical Medicine, Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, East Yorkshire HU16 5JT, UK.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Barbour A, Schmidt S, Ma B, Schiefelbein L, Rand KH, Burkhardt O, Derendorf H. Clinical Pharmacokinetics and Pharmacodynamics of Tigecycline. Clin Pharmacokinet 2009; 48:575-84. [DOI: 10.2165/11317100-000000000-00000] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
22
|
Pankey GA, Ashcraft DS. In vitro antibacterial activity of tigecycline against resistant Gram-negative bacilli and enterococci by time-kill assay. Diagn Microbiol Infect Dis 2009; 64:300-4. [PMID: 19501791 DOI: 10.1016/j.diagmicrobio.2009.03.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 03/11/2009] [Accepted: 03/21/2009] [Indexed: 11/28/2022]
Abstract
This time-kill study was performed with 65 genetically unique clinical isolates of Gram-negative bacilli and enterococci to further define the antibacterial activity of tigecycline. To our knowledge, this is the largest published time-kill study evaluating tigecycline activity to date. Isolates evaluated were 10 meropenem-resistant Acinetobacter baumannii; 15 Escherichia coli, including 10 extended-spectrum beta-lactamase (ESBL) producers; 15 Klebsiella pneumoniae, including 10 ESBL producers; 20 vancomycin-resistant Enterococcus faecium (VRE), including 10 that were linezolid resistant; and 5 vancomycin-susceptible Enterococcus faecalis. Time-kill testing was performed using tigecycline concentrations of 1x, 2x, and 4x MIC with colony-forming units (CFU) per milliliter determined at 0, 4, 8, 12, 24, 36, and 48 h. Tigecycline MICs (microg/mL) were < or =1 for E. coli and K. pneumoniae, regardless of the isolates' ESBL production; A. baumannii, 0.06 to 4; 9/10 (90%) were < or =2; E. faecalis < or =0.12; and VRE < or =0.25, regardless of linezolid susceptibility. In the time-kill assay, tigecycline significantly inhibited bacterial growth when compared with the growth control. The reduction in growth was <3 log(10) CFU/mL for all isolates, indicative of a bacteriostatic effect.
Collapse
Affiliation(s)
- George A Pankey
- Infectious Disease Research, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
| | | |
Collapse
|
23
|
Abstract
Tigecycline derived from minocycline. It is part of a new class of antibiotics called glycylcyclines. Tigecycline is given intravenously and has activity against a variety of gram-positive and gram-negative bacterial pathogens, many of which are resistant to existing antibiotics. Tigecycline successfully completed phase III trials in which it was at least equal to intravenous vancomycin and aztreonam to treat complicated skin and skin structure infections (cSSSI), and to intravenous imipenem and cilastatin to treat complicated intra-abdominal infections (cIAI). Tigecycline side effects are primarily digestive upset. It should be a valuable addition to the armamentarium to treat even the most resistant pathogens.
Collapse
Affiliation(s)
- Noah Scheinfeld
- Department of Dermatology, St Lukes Roosevelt Hospital, New York, USA.
| |
Collapse
|
24
|
Abstract
Investigations of antibiotic resistance from an environmental prospective shed new light on a problem that was traditionally confined to a subset of clinically relevant antibiotic-resistant bacterial pathogens. It is clear that the environmental microbiota, even in apparently antibiotic-free environments, possess an enormous number and diversity of antibiotic resistance genes, some of which are very similar to the genes circulating in pathogenic microbiota. It is difficult to explain the role of antibiotics and antibiotic resistance in natural environments from an anthropocentric point of view, which is focused on clinical aspects such as the efficiency of antibiotics in clearing infections and pathogens that are resistant to antibiotic treatment. A broader overview of the role of antibiotics and antibiotic resistance in nature from the evolutionary and ecological prospective suggests that antibiotics have evolved as another way of intra- and inter-domain communication in various ecosystems. This signalling by non-clinical concentrations of antibiotics in the environment results in adaptive phenotypic and genotypic responses of microbiota and other members of the community. Understanding the complex picture of evolution and ecology of antibiotics and antibiotic resistance may help to understand the processes leading to the emergence and dissemination of antibiotic resistance and also help to control it, at least in relation to the newer antibiotics now entering clinical practice.
Collapse
Affiliation(s)
- Rustam I Aminov
- University of Aberdeen, Rowett Institute of Nutrition and Health, Greenburn Road, Aberdeen AB21 9SB, UK.
| |
Collapse
|
25
|
Entenza JM, Moreillon P. Tigecycline in combination with other antimicrobials: a review of in vitro, animal and case report studies. Int J Antimicrob Agents 2009; 34:8.e1-9. [PMID: 19162449 DOI: 10.1016/j.ijantimicag.2008.11.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 11/03/2008] [Accepted: 11/04/2008] [Indexed: 11/29/2022]
Abstract
Tigecycline has been investigated in combination with other antibacterials against a wide range of susceptible and multiresistant Gram-positive and Gram-negative bacteria. Combinations have been analysed in vitro, in animal models and in human case reports. In vitro, tigecycline combined with other antimicrobials produces primarily an indifferent response (neither synergy nor antagonism). Nevertheless, synergy occurred when tigecycline was combined with rifampicin against 64-100% of Enterococcus spp., Streptococcus pneumoniae, Enterobacter spp. and Brucella melitensis isolates. Combinations of tigecycline with amikacin also showed synergy for 40-100% of Enterobacter spp., Klebsiella pneumoniae, Proteus spp. and Stenotrophomonas maltophilia isolates. Moreover, bactericidal synergisms occurred with tigecycline plus amikacin against problematic Acinetobacter baumannii and Proteus vulgaris, and with colistin against K. pneumoniae. Data from animal experiments and case reports, although limited, displayed consistent beneficial activity of tigecycline in combination with other antibacterials against multiresistant organisms, including vancomycin against penicillin-resistant S. pneumoniae in experimental meningitis, gentamicin against Pseudomonas aeruginosa in experimental pneumonia, daptomycin against Enterococcus faecium endocarditis, and colistin against K. pneumoniae bacteraemia and P. aeruginosa osteomyelitis. Antagonism was extremely rare in vitro and was not reported in vivo. Thus, tigecycline may be combined with a second antimicrobial as part of a combination regimen.
Collapse
Affiliation(s)
- J M Entenza
- Department of Fundamental Microbiology, Faculty of Biology and Medicine, University of Lausanne, CH-1015 Lausanne, Switzerland.
| | | |
Collapse
|
26
|
Postantibiotic effect of tigecycline against 14 gram-positive organisms. Antimicrob Agents Chemother 2008; 53:782-4. [PMID: 19064899 DOI: 10.1128/aac.01122-08] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The in vitro postantibiotic effects (PAEs), postantibiotic sub-MIC effects (PA-SMEs), and sub-MIC effects of tigecycline were determined for 14 gram-positive and gram-negative organisms. The pneumococcal, staphylococcal, and enterococcal PAEs were 1.9 to 5.1, 2.9 to 5.7, and 3.9 to 6.1 h, respectively, and those for Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, and Acinetobacter baumannii were 1.1 to 5.0, 1.9 to 2.1, 1.7 to 1.8, 1.0 to 1.7, and 0.7 to 3 h, respectively. The PA-SMEs (four times the MIC) ranged from 6.7 to >11 h for gram-positive organisms and from 2.3 to >11.3 h for gram-negative organisms.
Collapse
|
27
|
Bonnet E. Endocardite à Enterococcus faecalis traitée avec succès par la daptomycine. Med Mal Infect 2008; 38 Spec No 2:4-6. [DOI: 10.1016/s0399-077x(08)75151-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
28
|
Song JY, Cheong HJ, Lee J, Sung AK, Kim WJ. Efficacy of monotherapy and combined antibiotic therapy for carbapenem-resistant Acinetobacter baumannii pneumonia in an immunosuppressed mouse model. Int J Antimicrob Agents 2008; 33:33-9. [PMID: 18835761 DOI: 10.1016/j.ijantimicag.2008.07.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 07/03/2008] [Accepted: 07/10/2008] [Indexed: 11/17/2022]
Abstract
Acinetobacter baumannii is an important cause of nosocomial infection with increasing carbapenem resistance. The aim of this study was to compare the efficacy of colistin+rifampicin and imipenem+rifampicin combinations with that of several other antibiotic regimens against carbapenem-resistant A. baumannii pneumonia using an immunosuppressed mouse model. Three different A. baumannii strains with diverse resistance mechanisms (OXA-51-, IMP-1- and VIM-2-type beta-lactamases) were used. Among the monotherapy regimens, only rifampicin significantly reduced the bacterial load in lungs 24 h after infection with the OXA-51-producing strain. Addition of rifampicin to either imipenem or colistin yielded synergistic results after 48 h. Rifampicin was bactericidal against the IMP-1-producing strain, and only the imipenem+rifampicin combination yielded synergistic effects. In contrast, rifampicin alone was not effective against the VIM-2-producing strain, but the imipenem+rifampicin combination was bacteriostatic even at 24 h post-infection. Tigecycline and amikacin were not effective against any of the three strains. Rifampicin-based combinations were effective against A. baumannii bacteraemia and improved survival regardless of the strain type. Contrary to the similar minimum inhibitory concentration results, the antibacterial effects of rifampicin were quite different according to the strains; a tailored antibiotic strategy must be considered in treatment. Addition of rifampicin to either imipenem or colistin would be effective.
Collapse
Affiliation(s)
- Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | | | | | | | | |
Collapse
|
29
|
Commentary on manuscript: Tigecycline for treating bloodstream infections: a critical analysis of the available evidence. Diagn Microbiol Infect Dis 2008. [DOI: 10.1016/j.diagmicrobio.2008.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
30
|
Makinson A, Le Moing V. [New anti-Gram+antibiotics: which role in infective endocarditis?]. Ann Cardiol Angeiol (Paris) 2008; 57:88-92. [PMID: 18395180 DOI: 10.1016/j.ancard.2008.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Accepted: 02/21/2008] [Indexed: 05/26/2023]
Abstract
Though the increased resistance to antibiotics observed worldwide is not a major concern in France, treatment of methicillin-resistant S. aureus has important limitations. New antibiotics have recently been marketed or will soon be (quinupristin-dalfopristin, linelozide, tigecyclin, daptomycin, ceftobiprole, dalbavancin). Their role, which has been documented in several forms of acute infections, remains to be established in infective endocarditis. At present, only treatment of methicillin-resistant S. aureus right-sided endocarditis justifies the use of daptomycin, preferably in association with rifampicin, when the use of vancomycin is not possible or contraindicated.
Collapse
Affiliation(s)
- A Makinson
- Maladies infectieuses et tropicales, hôpital Gui-de-Chauliac, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | | |
Collapse
|
31
|
Curcio D. Tigecycline for treating bloodstream infections: a critical analysis of the available evidence. Diagn Microbiol Infect Dis 2008; 61:358-9; author reply 360-1. [PMID: 18342476 DOI: 10.1016/j.diagmicrobio.2008.01.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 01/30/2008] [Indexed: 10/22/2022]
|
32
|
Cobo J, Morosini MI, Pintado V, Tato M, Samaranch N, Baquero F, Cantón R. Use of tigecycline for the treatment of prolonged bacteremia due to a multiresistant VIM-1 and SHV-12 β-lactamase–producing Klebsiella pneumoniae epidemic clone. Diagn Microbiol Infect Dis 2008; 60:319-22. [DOI: 10.1016/j.diagmicrobio.2007.09.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Revised: 09/14/2007] [Accepted: 09/23/2007] [Indexed: 10/22/2022]
|
33
|
Jenkins I. Linezolid- and vancomycin-resistant Enterococcus faecium endocarditis: successful treatment with tigecycline and daptomycin. J Hosp Med 2007; 2:343-4. [PMID: 17935250 DOI: 10.1002/jhm.236] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
34
|
Zimmerman JJ, Harper DM, Matschke K, Speth JL, Raible DG, Fruncillo RJ. Absence of an Interaction Between Tigecycline and Digoxin in Healthy Men. Pharmacotherapy 2007; 27:835-44. [PMID: 17542766 DOI: 10.1592/phco.27.6.835] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To evaluate a potential interaction between tigecycline and digoxin using pharmacokinetic and pharmacodynamic assessments. DESIGN Open-label, three-period, one-sequence crossover study. SETTING Hospital-affiliated, inpatient clinical pharmacology unit. SUBJECTS Twenty healthy men. INTERVENTION Tigecycline 100 mg was administered intravenously as a single dose on day 1 (period 1). Digoxin was administered as a 0.5-mg oral loading dose on day 7, followed by 0.25 mg/day on days 8-14 (period 2). Digoxin 0.25 mg/day was continued on days 15-19; in addition, on day 15, a loading dose of tigecycline 100 mg was administered intravenously, followed by 50 mg every 12 hours starting on the evening of day 15 through the morning of day 19 (period 3). MEASUREMENTS AND MAIN RESULTS Pharmacokinetic assessments were performed on days 1 and 19 for tigecycline and on days 14 and 19 for digoxin. Electrocardiographic parameters were measured at baseline and on days 1, 14, and 19 to assess digoxin pharmacodynamics. Serum tigecycline concentrations were determined by liquid chromatography with tandem mass spectrometry detection, and plasma and urine digoxin concentrations were determined by radioimmunoassay. Tigecycline area under the concentration-time curve (AUC), AUC from 0-12 hours (AUC(0-12)), weight-normalized clearance, and mean resistance time were not affected by concomitant multiple-dose digoxin administration, but tigecycline half-life was decreased during period 1, apparently due to fewer detectable terminal concentrations in some subjects. Digoxin steady-state AUC(0-24), weight-normalized oral dose clearance, cumulative amount of drug excreted in urine over 24 hours, renal clearance, and QTc (change from baseline) were not affected by multiple-dose tigecycline administration. CONCLUSION No significant effects of tigecycline on digoxin pharmacokinetics and pharmacodynamics were noted, but a small effect of digoxin on tigecycline pharmacokinetics cannot be ruled out due to design issues with period 1 of the study.
Collapse
|
35
|
Cercenado E. Tigecycline: a new antimicrobial agent against multiresistant bacteria. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/14750708.4.3.255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
36
|
Loh E, Ellis-Grosse E, Petersen PJ, Sum PE, Projan S. Tigecycline: a case study. Expert Opin Drug Discov 2007; 2:403-18. [DOI: 10.1517/17460441.2.3.403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
37
|
Affiliation(s)
- George A Pankey
- Department of Infectious Diseases, Ochsner Clinic Foundation, New Orleans, LA, USA
| | | |
Collapse
|
38
|
Doan TL, Fung HB, Mehta D, Riska PF. Tigecycline: a glycylcycline antimicrobial agent. Clin Ther 2006; 28:1079-1106. [PMID: 16982286 DOI: 10.1016/j.clinthera.2006.08.011] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Tigecycline, the first glycylcycline to be approved by the US Food and Drug Administration, is a structural analogue of minocycline that was designed to avoid tetracycline resistance mediated by ribosomal protection and drug efflux. It is indicated for the treatment of complicated skin and skin-structure infections and complicated intra-abdominal infections and is available for intravenous administration only. OBJECTIVE This article summarizes the in vitro and in vivo activities and pharmacologic and pharmacokinetic properties of tigecycline, and reviews its clinical efficacy and tolerability profile. METHODS Relevant information was identified through a search of MEDLINE (1966-April 2006), Iowa Drug Information Service (1966-April 2006), and International Pharmaceutical Abstracts (1970-April 2006) using the terms tigecycline, GAR-936, and glycylcycline. Also consulted were abstracts and posters from meetings of the Infectious Diseases Society of America and the Interscience Conference on Antimicrobial Agents and Chemotherapy (1999-2006) and documents provided for formulary consideration by the US manufacturer of tigecycline. RESULTS Like the tetracyclines, tigecycline binds to the 30S subunit of bacterial ribosomes and inhibits protein synthesis by preventing the incorporation of amino acid residues into elongating peptide chains. In vitro, tigecycline exhibits activity against a wide range of clinically significant gram-positive and gram-negative bacteria, including multidrug-resistant strains (eg, oxacillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Enterobacteriaceae), and anaerobes (eg, Bacteroides spp). In pharmacokinetic studies in human adults, tigecycline had a large Vd (7-9 L/kg), was moderately bound to plasma protein (71%-89%), had an elimination t(1/2) of 42.4 hours, and was eliminated primarily by biliary/fecal (59%) and renal (33%) excretion. Dose adjustment did not appear to be necessary based on age, sex, renal function, or mild to moderate hepatic impairment (Child-Pugh class A-B). In patients with severe hepatic impairment (Child-Pugh class C), the maintenance dose should be reduced by 50%. In 4 Phase III clinical trials in patients with complicated skin and skin-structure infections and complicated intra-abdominal infections, tigecycline was reported to be noninferior to its comparators (vancomycin + aztreonam in 2 studies and imipenem/cilastatin in 2 studies), with clinical cure rates among clinically evaluable patients of >80% (P < 0.001 for noninferiority). The most frequently reported (> or =5 %) adverse events with tigecycline were nausea (28.5%), vomiting (19.4%), diarrhea (11.6%), local IV-site reaction (8.2%), infection (6.7%), fever (6.3%), abdominal pain (6.0%), and headache (5.6%). The recommended dosage of tigecycline is 100 mg IV given as a loading dose, followed by 50 mg IV g12h for 5 to 14 days. CONCLUSIONS In clinical trials, tigecycline was effective for the treatment of complicated skin and skin-structure infections and complicated intra-abdominal infections. With the exception of gastrointestinal adverse events, tigecycline was generally well tolerated. With a broad spectrum of activity that includes multidrug-resistant gram-positive and gram-negative pathogens, tigecycline may be useful in the treatment of conditions caused by these pathogens.
Collapse
Affiliation(s)
- Thien-Ly Doan
- Pharmacy Department, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Horatio B Fung
- Medicine/Surgery Patient Care Center, James Peters VA Medical Center, Bronx, New York, USA.
| | - Dhara Mehta
- Pharmacy Service, James Peters VA Medical Center, Bronx, New York, USA
| | - Paul F Riska
- Infections Diseases Section, James Peters VA Medical Center, Bronx, New York, USA
| |
Collapse
|
39
|
Abstract
Tigecycline is the first commercially available member of the glycylcyclines, a new class of antimicrobial agents. The glycylcyclines are derivatives of the tetracycline antibiotics, with structural modifications that allow for potent gram-positive, gram-negative, and anaerobic activity, including certain multidrug-resistant strains. The enhanced activity can be attributed to stronger binding affinity and enhanced protection against several mechanisms of resistance that affect other antibiotic classes such as tetracyclines. Tigecycline exhibits generally bacteriostatic action by reversibly binding to the 30S ribosomal subunit and inhibiting protein translation. In vitro activity has been demonstrated against multidrug-resistant gram-positive pathogens including methicillin-resistant and glycopeptide-intermediate and -resistant Staphylococcus aureus, as well as vancomycin-resistant enterococci. Multidrug-resistant gram-negative pathogens, such as Acinetobacter baumannii and extended-spectrum beta-lactamase-producing Klebsiella pneumoniae and Escherichia coli, are typically highly susceptible to tigecycline. The drug also has displayed significant activity against many clinically important anaerobic organisms. This agent demonstrates a predictable pharmacokinetic profile and minimal drug interactions, and is generally well tolerated, with nausea being the most common adverse event. It was approved in June 2005 for the treatment of complicated skin and skin structure infections (SSSIs) and complicated intraabdominal infections. Currently, a limited number of broad-spectrum antimicrobials are available to combat multidrug-resistant organisms. The addition of new agents is essential to limiting the spread of these pathogens and improving outcomes in patients with these types of infections. Tigecycline has demonstrated promising results in initial in vitro and clinical studies for SSSIs and complicated intraabdominal infections; however, further clinical experience will clarify its role as a broad-spectrum agent.
Collapse
Affiliation(s)
- Warren E Rose
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan 48201, USA
| | | |
Collapse
|
40
|
Abstract
Tigecycline is a new glycyclcycline antimicrobial recently approved for use in the USA, Europe and elsewhere. While related to the tetracyclines, tigecycline overcomes many of the mechanisms responsible for resistance to this class. It demonstrates favourable in vitro potency against a variety of aerobic and anaerobic Gram-positive and Gram-negative pathogens, including those frequently demonstrating resistance to multiple classes of antimicrobials. This includes methicillin-resistant Staphylococcus aureus, penicillin-resistant S. pneumoniae, vancomycin-resistant enterococci, Acinetobacter baumannii, beta-lactamase producing strains of Haemophilis influenzae and Moraxella catarrhalis, and extended-spectrum beta-lactamase producing strains of Escherichia coli and Klebsiella pneumoniae. In contrast, minimum inhibitory concentrations for Pseudomonas and Proteus spp. are markedly elevated. Tigecycline is administered parenterally twice daily. Randomised, controlled trials have demonstrated that tigecycline is non-inferior to the comparators for the treatment of complicated skin and skin structure infections, as well as complicated intra-abdominal infections. The most frequent and problematic side effect associated with its administration to date has been nausea and/or vomiting.
Collapse
Affiliation(s)
- M L Townsend
- Department of Pharmacy Practice, Campbell University School of Pharmacy, Buies Creek, NC, USA.
| | | | | |
Collapse
|
41
|
Noskin GA. Tigecycline: a new glycylcycline for treatment of serious infections. Clin Infect Dis 2006; 41 Suppl 5:S303-14. [PMID: 16080069 DOI: 10.1086/431672] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Tigecycline is a new semisynthetic glycylcycline for the treatment of serious infections. Of the glycylcyclines, tigecycline is the most studied and appears to hold promise as a new antimicrobial agent that can be administered as monotherapy to patients with many types of serious bacterial infections. For patients with serious infections, the initial choice for empirical therapy with broad-spectrum antibiotics is crucial, and, if the choice is inappropriate, it may have adverse consequences for the patient. Tigecycline has been designed to overcome many existing mechanisms of resistance among bacteria and confers broad antibiotic coverage against vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and many species of multidrug-resistant gram-negative bacteria. Tigecycline has been efficacious and well tolerated in human clinical phase 2 studies, which warranted further evaluation of tigecycline in larger studies for treatment of many indications, including complicated skin and skin-structure infections, complicated intra-abdominal infections, and infections of the lower respiratory tract.
Collapse
Affiliation(s)
- Gary A Noskin
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA.
| |
Collapse
|
42
|
Stein GE, Craig WA. Tigecycline: A Critical Analysis. Clin Infect Dis 2006; 43:518-24. [PMID: 16838243 DOI: 10.1086/505494] [Citation(s) in RCA: 192] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2005] [Accepted: 03/20/2006] [Indexed: 11/03/2022] Open
Abstract
Tigecycline (GAR-936) is the first glycylcycline antibiotic to be approved by the US Food and Drug Administration (FDA). The drug overcomes the 2 major resistance mechansisms of tetracycline: drug-specific efflux pump acquisition and ribosomal protection. Tigecycline is active against many gram-positive and -negative organisms, including methicillin-resistant Staphylococcus aureus, vancomycin-intermediate and -resistant enterococci, and extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae. It is also active against many anaerobic bacteria, as well as atypical pathogens, including rapidly growing, nontuberculous mycobacteria. Tigecycline is concentrated in cells and is eliminated primarily via biliary excretion. Diminished renal function does not significantly alter its systemic clearance. Furthermore, tigecycline does not interfere with common cytochrome P450 enzymes, making pharmacokinetic drug interactions uncommon. It provides parenteral therapy for complicated skin/skin-structure and intra-abdominal infections. The only prominent adverse effects are associated with tolerability, most notably nausea and vomiting. Tigecycline will be most useful as empirical therapy for polymicrobial infections, especially in cases in which deep tissue penetration is needed or in which multidrug-resistant pathogens are suspected.
Collapse
Affiliation(s)
- Gary E Stein
- Department of Medicine, Michigan State University, East Lansing, Michigan 48824, USA.
| | | |
Collapse
|
43
|
Abstract
Antibacterials have been in clinical use for almost 60 years; however, the effectiveness of these valuable agents has been diminished by widespread emergence of bacterial resistance. Tigecycline is the first in a new class of glycylcyclines with activity against a wide range of clinically important pathogens. Tigecycline has demonstrated potent microbiological activity and excellent therapeutic response in animal infection models and in recently reported phase III human clinical trials. It is effective against intra-abdominal and skin and soft tissue infections caused by susceptible or multidrug-resistant staphylococci, enterococci or streptococci as well as most Enterobacteriaceae and anaerobic pathogens. In clinical trials nausea and vomiting were the most common adverse events and were of a magnitude typical of those observed with tetracyclines in general. Additionally, tigecycline has proven to be efficacious in animal models of infection, including pneumonia, endocarditis and peritonitis. Tigecycline is only available as an intravenous agent and distributes extensively in tissues. Administration of a 100mg loading dose of tigecycline followed by twice-daily doses of 50mg yielded an apparent volume of distribution of 7-10 L/kg. Systemic clearance ranged from 0.2 to 0.3 L/h/kg and its half-life varied from 37 to 67 hours. The pharmacokinetics of tigecycline appear unaffected by sex, age, renal disease or the presence of food. Data from animal studies would suggest that time above the minimum inhibitory concentration is the pharmacodynamic factor that best correlates with bacterial eradication. The efficacy, safety profile and pharmacodynamic attributes of tigecycline support its continuing clinical development as empirical parenteral treatment of challenging nosocomial and community-acquired infections, including those caused by proven or suspected resistant pathogens.
Collapse
Affiliation(s)
- Ethan Rubinstein
- Section of Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.
| | | |
Collapse
|
44
|
Sum PE. Case studies in current drug development: 'glycylcyclines'. Curr Opin Chem Biol 2006; 10:374-9. [PMID: 16807065 DOI: 10.1016/j.cbpa.2006.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Accepted: 06/12/2006] [Indexed: 10/24/2022]
Abstract
Glycylcyclines represent a new class of tetracycline antibiotics with potent antibacterial activities against resistant pathogens. One of the glycylcyclines, Tygacil, was selected for further development and has been approved by the FDA. It has an expanded broad-spectrum of antibacterial activity both in vitro and in vivo. It is active against a wide range of clinically relevant pathogens including Gram-positive, Gram-negative, atypical, and anaerobic bacteria and bacterial strains carrying either or both of the two major forms of tetracycline resistance (efflux and ribosomal protection). Most importantly, it is active against the multiply antibiotic resistant Gram-positive pathogenic bacteria, including methicillin-resistant Staphylococcus aureus (MRSA).
Collapse
Affiliation(s)
- Phaik-Eng Sum
- Chemical and Screening Sciences Department, Wyeth Research, 401 North Middletown Road, Pearl River, NY 10965, USA.
| |
Collapse
|
45
|
Tigecycline: an evidence-based review of its antibacterial activity and effectiveness in complicated skin and soft tissue and intraabdominal infections. CORE EVIDENCE 2006; 1:181-94. [PMID: 22500153 PMCID: PMC3321663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
INTRODUCTION There is an urgent need for novel agents to manage serious bacterial infections, particularly those contracted in healthcare facilities. Tigecycline is a novel broad-spectrum glycylcycline with good activity against Gram-positive, many Gram-negative, anaerobic, and some atypical pathogens that has been developed to address this need. AIMS To review the evidence for the use of tigecycline in serious and complicated skin and soft tissue and intraabdominal infections. EVIDENCE REVIEW There is substantial evidence that tigecycline is as effective as vancomycin plus aztreonam in complicated skin and skin structure infections (SSSIs) and as effective as imipenem plus cilastatin in intraabdominal infections. Limited evidence shows effectiveness in patients with resistant Acinetobacter infection in an intensive care unit, and the possibility that the use of tigecycline may reduce length of hospital stay. The drug is well tolerated, with nausea and vomiting as the major adverse effects. OUTCOMES SUMMARY The introduction of tigecycline should be beneficial at a time of increasing problems with bacterial resistance, and evidence to date has been sufficient for regulatory approval for complicated SSSIs and intraabdominal infections. Research into tigecycline's efficacy in other infectious diseases (notably pneumonia and bacteremia) is ongoing. Further good quality studies and ongoing surveillance for any emerging bacterial resistance will be needed to determine outcomes with tigecycline relative to other novel antibacterial agents, and to explore the economic implications of its adoption.
Collapse
|
46
|
Petersen PJ, Bradford PA. Effect of medium age and supplementation with the biocatalytic oxygen-reducing reagent oxyrase on in vitro activities of tigecycline against recent clinical isolates. Antimicrob Agents Chemother 2005; 49:3910-8. [PMID: 16127070 PMCID: PMC1195416 DOI: 10.1128/aac.49.9.3910-3918.2005] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In determining the quality control limits for the Clinical Laboratory Standards Institute-recommended quality control organisms with tigecycline, a number of inconsistencies in the results were encountered that appeared to be related to the age of the Mueller-Hinton broth II. This study was performed to examine the effect of medium age and supplementation with Oxyrase on the activity of tigecycline using a large number of clinical isolates.
Collapse
Affiliation(s)
- Peter J Petersen
- Infectious Disease Research, Wyeth Research, Bldg. 200, Rm. 3301, 401 N. Middletown Rd., Pearl River, NY 10965, USA.
| | | |
Collapse
|
47
|
Abstract
New antimicrobial agents are urgently needed for clinical use due to the increasing prevalence and spread of multidrug-resistant bacteria that are commonly responsible for serious and life-threatening diseases. The need to develop new agents that effectively overcome existing mechanisms of resistance displayed by bacteria resistant to currently available drugs has become paramount. Tigecycline, the first in a new class of antimicrobials, the glycylcyclines, is an analogue of minocycline with additional properties that negate most mechanisms mediating resistance to the tetracyclines. In vitro testing has revealed that tigecycline has activity against vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae and many species of multidrug-resistant Gram-negative bacteria, although resistance to tigecycline by Pseudomonas aeruginosa and reduced susceptibility among Proteus species do occur. Tigecycline is being evaluated in multicentre Phase III clinical trials for therapy of many serious and life-threatening infections in which multidrug-resistant bacterial organisms may be found. Tigecycline appears to hold promise as a novel expanded spectrum antibiotic.
Collapse
Affiliation(s)
- George A Pankey
- Infectious Diseases Research, Ochsner Clinic Foundation LT 7S, 1514 Jefferson Highway, New Orleans, LA 70121-2483, USA.
| |
Collapse
|
48
|
Betriu C, Culebras E, Gómez M, Rodríguez-Avial I, Picazo JJ. In vitro activity of tigecycline against Bacteroides species. J Antimicrob Chemother 2005; 56:349-52. [PMID: 15951353 DOI: 10.1093/jac/dki197] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To ascertain the current susceptibility patterns of members of the Bacteroides fragilis group in our hospital and to assess the in vitro activity of tigecycline against these organisms. METHODS A total of 400 non-duplicate clinical isolates of the B. fragilis group collected from 2000 to 2002 were studied. Susceptibility testing was performed according to the reference agar dilution method described by the NCCLS. The following antimicrobials were tested: tigecycline, clindamycin, metronidazole, chloramphenicol, cefoxitin, imipenem, amoxicillin-clavulanate and piperacillin-tazobactam. RESULTS All strains were susceptible to metronidazole and chloramphenicol. For clindamycin and cefoxitin, the overall susceptibility rates were 59.5% and 83%, respectively. Imipenem and piperacillin-tazobactam were the most active beta-lactam agents tested. Tigecycline inhibited 89.8% of the strains at a concentration of 8 mg/L with an MIC range of <or=0.01 to >16 mg/L. By comparing the MIC50 and MIC90 values of tigecycline among the various species of the group, B. fragilis, Bacteroides thetaiotaomicron and Bacteroides vulgatus were the most susceptible (MIC50/MIC90s of 0.5-1/8 mg/L). CONCLUSIONS Tigecycline exhibited activity against most isolates of the B. fragilis group tested. These results indicate that tigecycline may be useful in the treatment and prophylaxis of infections involving these organisms.
Collapse
Affiliation(s)
- C Betriu
- Department of Clinical Microbiology, Hospital Clínico San Carlos, 28040 Madrid, Spain.
| | | | | | | | | |
Collapse
|
49
|
Muralidharan G, Fruncillo RJ, Micalizzi M, Raible DG, Troy SM. Effects of age and sex on single-dose pharmacokinetics of tigecycline in healthy subjects. Antimicrob Agents Chemother 2005; 49:1656-9. [PMID: 15793165 PMCID: PMC1068643 DOI: 10.1128/aac.49.4.1656-1659.2005] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The pharmacokinetics of tigecycline was evaluated in 46 healthy young and elderly men and women. Except for the volumes of distribution at steady state (approximately 350 liters in women versus 500 liters in men), there were no significant differences in tigecycline pharmacokinetic parameters. Based on pharmacokinetics, no dosage adjustment is warranted based on age or sex.
Collapse
|
50
|
Betriu C, Gómez M, Rodríguez-Avial I, Culebras E, Picazo JJ. In vitro activity of tigecycline against ampicillin-resistant Haemophilus influenzae isolates. J Antimicrob Chemother 2005; 55:809-10. [PMID: 15790670 DOI: 10.1093/jac/dki096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|