minocycline and Digestive-System-Diseases

Tigecycline is the first of a new class of antibiotics, the glycylcyclines, with properties which can overcome many common resistance mechanisms, making it appropriate for treatment of many serious and life-threatening infections for which other antibiotics are no longer appropriate. its wide antibacterial spectrum includes most methicillin-resistant staphylococci, vancomycin-resistant enterococci, ESBL-producing and other multi-resistant Gram-negative bacteria such as Acinetobacter and Stenotrophomonas spp. it is also active against anaerobes and atypical pathogens. Tigecycline is available only as parenteral formulation. it has a high volume of distribution (>10 L/kg) and long half-life (36 h). It is approved in the USA and europe for treatment of complicated skin and soft tissue infections and complicated communityacquired intra-abdominal infections. Phase II studies for treatment of community- and nosocomial-acquired pneumonia and sepsis due to multidrug resistant pathogens are ongoing.

Topics: Anti-Bacterial Agents; Clinical Trials as Topic; Community-Acquired Infections; Digestive System Diseases; Humans; Infections; Minocycline; Soft Tissue Infections; Tigecycline

This article examines and discusses some of the most pertinent recent literature on the new glycylcycline antibiotic, tigecycline, in relation to its use for treatment of intraabdominal infections.

Topics: Anti-Bacterial Agents; Clinical Trials as Topic; Digestive System Diseases; Humans; Infections; Minocycline; Tigecycline

The pharmacodynamic and pharmacokinetic characteristics of antimicrobial agents are the two fundamental pharmacological components which provide a rationale for the choice of therapy for intraabdominal infections, and especially serious infections. The most important PK-PD parameters are well known which can potentiate therapeutic efficacy. Antimicrobial agents can be subdivided into categories based on whether their activity is dependent on concentration or exposure time. Therefore, a correct dosing regimen for the time-dependent molecules (i.e. beta-lactams, linezolid, tigecycline) should prolong the maximum exposure time to maintain serum levels over the minimum inhibitory concentration (MIC). The concentration-dependent molecules, on the other hand, which include aminoglycosides and fluoroquinolones, should be given in order to reach maximum concentrations, since they are bactericidal in direct proportion to their concentrations and possess a prolonged post-antibiotic effect.

Topics: Abdominal Abscess; Acetamides; Aminoglycosides; Anti-Bacterial Agents; Anti-Infective Agents; beta-Lactams; Digestive System Diseases; Drug Therapy, Combination; Fluoroquinolones; Humans; Linezolid; Metronidazole; Microbial Sensitivity Tests; Minocycline; Oxazolidinones; Peritonitis; Sepsis; Tigecycline; Treatment Outcome; Virginiamycin

Tigecycline is a new antimicrobial agent; it is the first in a new class of antibiotics, the glycylcyclines, with properties conferring the ability to overcome many common resistance mechanisms, thus allowing its use for many serious and life-threatening infections for which the use of other antibiotics is no longer appropriate. It has a wide antibacterial spectrum including most methicillin-resistant Staphylococci, vancomycin-resistant Enterococci, ESBL-producing Gram negative bacteria, and other MDR Gram negative bacteria such as Acinetobacter, and Stenotrophomonas. It has good antibacterial activity also against anaerobes and atypical pathogens. Tigecycline is available only as parenteral formulation. It has a high volume of distribution (>10 l/kg), and long half-life (36 hrs). It has been approved in USA and Europe for the treatment of complicated skin and soft tissue infections and for the complicated community acquired intra-abdominal infections. Phase III studies for treatment of community acquired and nosocomial acquire pneumonia, and sepsis sustained by multi-drug-resistant pathogens are ongoing.

Topics: Abdominal Cavity; Anti-Bacterial Agents; Cross Infection; Digestive System Diseases; Humans; Injections, Intravenous; Microbial Sensitivity Tests; Minocycline; Tigecycline; Treatment Outcome

Source control, any procedure used to control the source of a major infection, is critical to the resolution of intra-abdominal infections. We sought to characterize whether surgeons agree on methods of source control for patients who had persistent infection despite initial surgical treatment and antimicrobials.. We analyzed source control decisions in a trial comparing tigecycline with imipenem in the treatment of intra-abdominal infections for patients who were clinical failures and had persistent abdominal infections after treatment with antibiotics and undergoing source control.. We found that source control agreement was least among patients who had Acute Physiology and Chronic Health Evaluation (APACHE) II scores greater than 15 (kappa = -.17, P = .533) and those with complicated appendicitis (kappa = .08, P = .446). There was excellent agreement in the source control decisions for perforation (kappa = .76, P = 0.002) and diverticulitis (kappa = 1.00, P = .005).. Agreement on source control is lacking on more severely ill patients and those with complicated appendicitis. These data should be used to seek optimal management for these conditions and to minimize variability in future clinical trials of intra-abdominal infection.

Topics: Abdominal Abscess; Abdominal Cavity; Aged; Anti-Bacterial Agents; Appendicitis; Cholecystitis; Decision Making; Digestive System Diseases; Diverticulitis; Double-Blind Method; Female; Humans; Imipenem; Intestinal Perforation; Male; Middle Aged; Minocycline; Peritonitis; Professional Practice; Tigecycline