minocycline and Intestinal-Diseases

Treatment of complicated skin and skin structure infection (cSSSI) and complicated intra-abdominal infection (cIAI) currently present a therapeutic challenge because many of the pathogens involved are becoming resistant to standard antimicrobial therapy. Tigecycline is a novel glycylcycline that exhibits expanded broad-spectrum antibacterial activity against certain resistant pathogens. Results from randomised Phase III studies comparing the clinical and microbiological efficacy of tigecycline with combination antimicrobial therapy for the treatment of cSSSI and cIAI are encouraging. Tigecycline has the potential to be used as monotherapy for the treatment of cSSSI and cIAI.

Topics: Abdominal Abscess; Anti-Bacterial Agents; Bacterial Infections; Humans; Intestinal Diseases; Minocycline; Skin Diseases, Bacterial; Tigecycline

This pooled analysis includes 2 phase 3, double-blind trials designed to evaluate the safety and efficacy of tigecycline, versus that of imipenem-cilastatin, in 1642 adults with complicated intra-abdominal infections. Patients were randomized to receive either tigecycline (initial dose of 100 mg, followed by 50 mg intravenously every 12 h) or imipenem-cilastatin (500/500 mg intravenously every 6 h) for 5-14 days. The primary end point was the clinical response at the test-of-cure visit (12-42 days after therapy) in the co-primary end point microbiologically evaluable and microbiological modified intent-to-treat populations. For the microbiologically evaluable group, clinical cure rates were 86.1% (441/512) for tigecycline, versus 86.2% (442/513) for imipenem-cilastatin (95% confidence interval for the difference, -4.5% to 4.4%; P < .0001 for noninferiority). Clinical cure rates in the microbiological modified intent-to-treat population were 80.2% (506/631) for tigecycline, versus 81.5% (514/631) for imipenem-cilastatin (95% confidence interval for the difference, -5.8% to 3.2%; P < .0001 for noninferiority). Nausea (24.4% tigecycline, 19.0% imipenem-cilastatin [P = .01]), vomiting (19.2% tigecycline, 14.3% imipenem-cilastatin [P = .008]), and diarrhea (13.8% tigecycline, 13.2% imipenem-cilastatin [P = .719]) were the most frequently reported adverse events. This pooled analysis demonstrates that tigecycline was efficacious and well tolerated in the treatment of patients with complicated intra-abdominal infections.

Topics: Adult; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Female; Humans; Imipenem; Intestinal Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Minocycline; Tigecycline

A patient genetically diagnosed with X-linked agammaglobulinemia repeatedly developed bacteremia due to Campylobacter coli (C. coli) for one year and seven months in spite of immunoglobulin replacement therapy. Throughout the clinical course, C. coli with identical genetic patterns was repeatedly isolated from both blood and stool cultures, thus indicating that the patient had latent intestinal infection. The bacteremia was always accompanied by reactive arthritis. Since the immunoglobulin level was extremely low with severe B cell deficiency, the reactive arthritis must have been induced in a humoral immunity-independent manner. Adding oral minocycline following intravenous meropenem was very effective; the stool cultures became negative and the patient has been well for more than one year without relapse of bacteremia.

Topics: Administration, Oral; Adult; Agammaglobulinemia; Anti-Bacterial Agents; Arthritis, Reactive; Bacteremia; Campylobacter coli; Campylobacter Infections; Chromosomes, Human, X; Feces; Genetic Linkage; Humans; Injections, Intravenous; Intestinal Diseases; Male; Meropenem; Minocycline; Recurrence; Thienamycins; Treatment Outcome

The in vitro activity of tigecycline was evaluated against 4913 baseline pathogens isolated from 1986 patients enrolled in 4 pivotal phase 3 clinical trials. The trials, which were conducted in 38 countries worldwide, involved patients with complicated skin and skin-structure infections or complicated intra-abdominal infections. Tigecycline was active against the most prevalent pathogens for each infection type, including gram-positive and gram-negative strains of both aerobic and anaerobic bacteria (MICs, < or =2 microg/mL for most pathogens). The spectrum of activity of tigecycline included important pathogens, such as Staphylococcus aureus (including methicillin-resistant S. aureus), Streptococcus pyogenes, Escherichia coli, Klebsiella pneumoniae, and Bacteroides fragilis. A few genera, such as Pseudomonas aeruginosa and members of the tribe Proteeae, were generally less susceptible to tigecycline than were other gram-negative pathogens. The susceptibility of the pathogens to tigecycline was similar for isolates obtained from patients enrolled in the studies of complicated skin and skin-structure infection or of complicated intra-abdominal infection. For most pathogens, the susceptibility to tigecycline was similar across all geographic regions. The excellent expanded broad-spectrum activity of tigecycline demonstrated in vitro against clinical isolates confirmed its potential utility for pathogens associated with complicated skin and skin-structure infections or complicated intra-abdominal infections.

Topics: Anti-Bacterial Agents; Bacterial Infections; Clinical Trials, Phase III as Topic; Drug Resistance, Multiple, Bacterial; Humans; Intestinal Diseases; Microbial Sensitivity Tests; Minocycline; Skin Diseases, Bacterial; Tigecycline