Best tigecycline dosing for treatment of infections caused by multidrug-resistant pathogens in critically ill patients with different body weights

Mohamed M Ibrahim,1 Abdulla M Abuelmatty,2 Gehan H Mohamed,3 Mohsen A Nasr,4 Amal K Hussein,5 Mohy El Deen Ebaed,6 Hatem A Sarhan5 1Department of Clinical Pharmacy, Faculty of Pharmacy, Minia University, Minia, Egypt; 2Department of Pharmacy, Jahra Hospital, Jahra, Kuwait; 3Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt; 4Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 5Department of Pharmaceutics, Faculty of Pharmacy, Minia University, Minia, Egypt; 6Department of Biochemistry, Egyptian Ministry of Interior, Cairo, Egypt Background: The intensive care unit (ICU) is a center of multidrug-resistant (MDR) pathogens. This is due to overuse of antibiotics in the treatment of critically ill patients. Tigecycline is a broad-spectrum antibiotic that belongs to the glycylcycline group. Tigecycline has been indicated in treatment of complicated intra-abdominal infections (cIAIs) and complicated skin and soft-tissue infections (cSSTIs).Objective: This study was done to discover the best dose regimen of tigecycline in treatment of cSSTIs and cIAIs, especially in patients who are critically ill and obese, for clinical outcomes and safety.Setting: The study was conducted in an adult ICU that consists of 25 beds in a general hospital and was conducted within 2 years. A total of 954 patients were screened in this study.Methods: This was a retrospective cohort study that compared the clinical outcomes of patients: mortality, ICU stay, and safety of using two different dose regimens of tigecycline between patients with different body weight who were treated for infections caused by MDR pathogens in the ICU. The study was conducted within 2 years. All results were collected from patients’ files and were analyzed with SPSS version 20.Main outcome: The study was implemented to figure out the best dose regimen of tigecycline to achieve a reduction in mortality, ICU stay, treatment duration, and secondary septic-shock incidence with minimum side effects in treatment of cSSTIs and cIAIs in patients with different body weight.Results: There was a significant improvement in mortality, ICU stay, recurrent infection by the same organism, duration of tigecycline treatment, number of patients who had first negative culture after starting treatment, secondary bacteremia, and secondary septic shock with patients who used high-dose regimens of tigecycline in different subgroups of body weight, with no significant difference in side effects.Conclusion: The use of high-dose tigecycline resulted in a significant enhancement in all clinical outcomes, especially mortality and ICU stay when used in treatment of overweight and obese patients with cSSTIs and cIAIs. Keywords: tigecycline, obese patients, intensive care unit, complicated intra-abdominal infections, complicated skin and soft-tissue infections&nbsp