Influence of continuous renal replacement therapy on the plasma concentration of tigecycline in patients with septic shock: A prospective observational study

Huang, Fang; Cao, Wenxiang; Yan, Yuying; Mao, Tiantian; Wang, Xianwen; Huang, Dan; Qiu, Yu-Shuang; Liang, Wenjie; Li, Dongjie; Zhuang, Yu-Gang

doi:10.3389/fphar.2023.1118788

Cited by 3 publications

(2 citation statements)

References 30 publications

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“…Based on blood concentration monitoring and prescription review analysis, the results of the present study suggested that, for the rational use of tigecycline, the first dose should be administered with loading (double dose), so that the steady-state trough concentration can be reached quicker (19). This approach may improve efficacy and reduce the chance of drug resistance.…”

Section: Discussionmentioning

confidence: 90%

Rational use of tigecycline and tigecycline blood concentration monitoring in patients with severe infection

et al. 2023

Biomed Rep

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Tigecycline, a tetracycline antibiotic, is widely used against antimicrobial resistance; therefore, medical staff should use tigecycline rationally to improve clinical efficacy and reduce resistance to this drug. The present study aimed to enhance the rate of rational tigecycline usage. The patients were divided into a low-dose (50 mg tigecycline twice daily, every 12 h) and a high-dose group (100 mg twice daily, every 12 h). The blood concentrations of tigecycline were examined and the area under the curve (AUC) 0-12 h values of the two groups were calculated. Prescriptions of tigecycline for 40 intensive care unit (ICU) cases were reviewed to evaluate the rationality of tigecycline usage. The peak plasma concentrations (the 7th administration after 1 h) of tigecycline were significantly higher in the high-dose group (2.46±0.43 µg/ml) compared with those in the low-dose group (1.25±0.16 µg/ml). The AUC 0-12 h was 16.35±3.09 h µg/ml in the high-dose group and 9.83±1.23 h µg/ml in the low-dose group (P<0.001). There were 29 irrational prescriptions identified, involving: i) Lack of consultation records (n=20); ii) inappropriate usage or dosage (n=17); iii) inappropriate drug selection (n=2); or iv) lack of dynamic laboratory tests to evaluate the efficacy (n=4). The irrational use of tigecycline in ICU patients is common. The rate of rational tigecycline usage can be improved by strengthening the management, training and participation of clinical pharmacists.

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Section: Discussionmentioning

confidence: 90%

Rational use of tigecycline and tigecycline blood concentration monitoring in patients with severe infection

et al. 2023

Biomed Rep

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“…26 Furthermore, a pharmacokinetic study of patients with septic shock showed that the area under the concentration-time curve for tigecycline, calculated based on trough levels, was higher in patients on CRRT than in other patients. 27 Several studies have demonstrated renal dysfunction as a risk factor for various adverse tigecycline-related events, such as hypofibrinogenemia and pancreatitis. 28,29 Possibly, renal dysfunction also predisposes patients to hypoglycemia during tigecycline therapy by causing drug overexposure.…”

Section: Discussionmentioning

confidence: 99%

Tigecycline and Hypoglycemia, When and How?

Hakeam,

Sarkhi,

Iansavichene

2023

Journal of Pharmacy Technology

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Objective: To describe the clinical characteristics of hypoglycemia that develop with tigecycline therapy and to review and summarize the current evidence of this uncommonly occurring metabolic adverse effect of tigecycline therapy. Underlying risk factors and potential mechanisms are also discussed. Data source: A 3-phase literature search was performed. In phase 1, the Cochrane Central Register of Controlled Trials (CENTRAL) Library, MEDLINE, and Embase electronic databases were searched for hypoglycemia and tigecycline, published from inception until August 2023. In phase 2, MEDLINE was searched for tigecycline randomized controlled trials and results were manually screened for hypoglycemia. In phase 3, the US Food and Drug Administration Adverse Event Reporting System public dashboard was searched for reports on tigecycline and hypoglycemia from June 2005 until July 2023. Study selection and data extraction: Relevant English-language citations and those conducted in humans were considered. Relevance to patient care and clinical practice: Hypoglycemia of various causes is an independent mortality risk. This review raises awareness among clinicians about the possibility of hypoglycemia with tigecycline therapy. Conclusion: Data on tigecycline-related hypoglycemia are scarce. Hypoglycemia may occur at any time during tigecycline therapy and can be severe and persist for days after tigecycline cessation. Renal dysfunction or renal replacement therapy may predispose to severe hypoglycemia during tigecycline therapy. Tigecycline-related hypoglycemia may develop in patients with or without diabetes mellitus and appears independent of insulin or antidiabetic agents. Intravenous dextrose showed efficacy in the restoration of euglycemia. Studies are needed to determine whether tigecycline-related hypoglycemia is iatrogenic or spontaneous.

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Population Pharmacokinetics of Tigecycline for Critically Ill Patients Undergoing Continuous Renal Replacement Therapy

Song,

Liu,

et al. 2024

DDDT

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Background Tigecycline is considered one of the last resorts for treating infections caused by multidrug-resistant bacteria. Continuous renal replacement therapy (CRRT) is widely used in critically ill patients, especially those with acute kidney injury or severe infections. However, pharmacokinetic data for tigecycline in patients receiving CRRT are limited. Methods This was a single-center prospective clinical study with intensive sampling that included critically ill patients who received tigecycline and CRRT. A population pharmacokinetic (PPK) model was developed and evaluated by goodness-of-fit plots, bootstrap analysis, visual predictive checks, and numerical predictive checks. Pharmacokinetic/pharmacodynamic target attainment and cumulative fraction of response analyses were performed to explore the potential need for dose adjustments of tigecycline in CRRT. Results In total, 21 patients with 167 concentrations were included. A two-compartment model adequately described the tigecycline concentration–time points, but no covariates were found to adequately explain the viability in the pharmacokinetic parameters of tigecycline. The typical values of CL, Q, V1 and V2 were 4.42 L/h, 34.8 L/h, 30.9 L and 98.7 L, respectively. For most infections, the standard regimen of 50 mg/12 h was deemed appropriate, expect for skin and soft skin tissue infections and community-acquired pneumonia caused by Acinetobacter baumannii and Klebsiella pneumoniae , which required a dosage regimen of 100 mg/12 h or higher. Conclusion A tigecycline PPK model describing critically ill patients undergoing CRRT was successfully developed. The optimized dosage regimens for various infections are recommended.

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Influence of continuous renal replacement therapy on the plasma concentration of tigecycline in patients with septic shock: A prospective observational study

Cited by 3 publications

References 30 publications

Rational use of tigecycline and tigecycline blood concentration monitoring in patients with severe infection

Rational use of tigecycline and tigecycline blood concentration monitoring in patients with severe infection

Tigecycline and Hypoglycemia, When and How?

Population Pharmacokinetics of Tigecycline for Critically Ill Patients Undergoing Continuous Renal Replacement Therapy

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