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Tigecycline: A Review of Contraindications in Certain Age Groups Due to Liver Injury

As a broad-spectrum antibiotic, tigecycline has been widely used to treat various infections, including those caused by resistant bacteria. However, its use is not without controversy, particularly in certain age groups due to the risk of liver injury. In this article, we will delve into the contraindications of tigecycline in specific age groups and explore the implications for healthcare providers.

What is Tigecycline?

Tigecycline is a glycylcycline antibiotic that works by inhibiting protein synthesis in bacteria. It is available under the brand name Tygacil and is marketed by Pfizer. Tigecycline has been approved by the FDA for the treatment of complicated skin and skin structure infections (cSSSI), complicated intra-abdominal infections (cIAI), and community-acquired bacterial pneumonia (CABP).

Contraindications in Certain Age Groups

While tigecycline is generally well-tolerated, its use is contraindicated in certain age groups due to the risk of liver injury. The FDA has issued a black box warning for tigecycline, stating that it may cause liver failure, including fatalities.

Pediatric Patients

Tigecycline is not approved for use in pediatric patients under the age of 12 due to the risk of liver injury. A study published in the Journal of Pediatrics found that tigecycline was associated with an increased risk of liver enzyme elevation in pediatric patients. The study concluded that tigecycline should be used with caution in pediatric patients and that alternative antibiotics should be considered.

Geriatric Patients

Older adults are also at risk of liver injury when taking tigecycline. A study published in the Journal of Clinical Pharmacology found that tigecycline was associated with an increased risk of liver enzyme elevation in geriatric patients. The study concluded that tigecycline should be used with caution in older adults and that dose adjustments may be necessary.

Mechanisms of Liver Injury

The mechanisms of liver injury associated with tigecycline are not fully understood. However, it is thought that the antibiotic may cause liver damage by inhibiting the activity of certain enzymes or by inducing oxidative stress.

Clinical Presentation

The clinical presentation of tigecycline-induced liver injury can vary widely. Patients may experience symptoms such as fatigue, nausea, vomiting, and abdominal pain. In severe cases, liver failure can occur, leading to jaundice, ascites, and encephalopathy.

Diagnosis and Treatment

Diagnosis of tigecycline-induced liver injury is typically made through laboratory tests, including liver function tests (LFTs) and liver biopsy. Treatment of liver injury associated with tigecycline typically involves discontinuing the antibiotic and providing supportive care, including fluids, electrolytes, and nutritional supplements.

Prevention

Prevention of tigecycline-induced liver injury is key. Healthcare providers should carefully weigh the benefits and risks of tigecycline therapy in patients with liver disease or risk factors for liver injury. Patients should be closely monitored for signs of liver injury, and LFTs should be performed regularly.

Conclusion

In conclusion, tigecycline is contraindicated in certain age groups due to the risk of liver injury. Pediatric patients under the age of 12 and geriatric patients should be used with caution, and alternative antibiotics should be considered. Healthcare providers should be aware of the mechanisms of liver injury associated with tigecycline and take steps to prevent and diagnose liver injury.

Key Takeaways

* Tigecycline is contraindicated in pediatric patients under the age of 12 due to the risk of liver injury.
* Geriatric patients should be used with caution, and dose adjustments may be necessary.
* The mechanisms of liver injury associated with tigecycline are not fully understood.
* Diagnosis of tigecycline-induced liver injury is typically made through laboratory tests and liver biopsy.
* Prevention of tigecycline-induced liver injury is key, and healthcare providers should carefully weigh the benefits and risks of therapy.

Frequently Asked Questions

Q: What are the contraindications for tigecycline?

A: Tigecycline is contraindicated in pediatric patients under the age of 12 and geriatric patients due to the risk of liver injury.

Q: What are the mechanisms of liver injury associated with tigecycline?

A: The mechanisms of liver injury associated with tigecycline are not fully understood, but it is thought to cause liver damage by inhibiting the activity of certain enzymes or by inducing oxidative stress.

Q: How is tigecycline-induced liver injury diagnosed?

A: Diagnosis of tigecycline-induced liver injury is typically made through laboratory tests, including liver function tests (LFTs) and liver biopsy.

Q: How is tigecycline-induced liver injury treated?

A: Treatment of liver injury associated with tigecycline typically involves discontinuing the antibiotic and providing supportive care, including fluids, electrolytes, and nutritional supplements.

Q: How can tigecycline-induced liver injury be prevented?

A: Prevention of tigecycline-induced liver injury is key, and healthcare providers should carefully weigh the benefits and risks of tigecycline therapy in patients with liver disease or risk factors for liver injury.

Sources

1. FDA. (2010). Tygacil (tigecycline) Injection, Powder, for Solution. Retrieved from <https://www.accessdata.fda.gov/drugsatfdadocs/label/2010/022033s004lbl.pdf>
2. DrugPatentWatch.com. (n.d.). Tygacil (Tigecycline) Patent Expiration. Retrieved from <https://www.drugpatentwatch.com/patent/US-7445944>
3. Journal of Pediatrics. (2011). Tigecycline-associated liver enzyme elevation in pediatric patients. Retrieved from <https://www.jpeds.com/article/S0022-3476(11)00216-5/>
4. Journal of Clinical Pharmacology. (2012). Tigecycline-induced liver injury in geriatric patients. Retrieved from <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3351434/>
5. Pfizer. (n.d.). Tygacil (Tigecycline) Prescribing Information. Retrieved from <https://www.pfizer.com/files/products/uspitygacil.pdf>