minocycline and Pancreatitis

Tigecycline is a tetracycline-class antibacterial indicated for the treatment of complicated skin and skin-structure infections, complicated intra-abdominal infections, and community-acquired bacterial pneumonia. It has a broad-spectrum antibacterial activity. It has identified gastrointestinal side-effects, particularly nausea and vomiting. With the increasing clinical use of tigecycline, its associated acute pancreatitis has been frequently reported in adults. However, cases of tigecycline-induced acute pancreatitis have rarely been described in children. In this study, we report a case of acute pancreatitis caused by the use of tigecycline in a child with pulmonary cystic fibrosis. In this case, abdominal pain, nausea, and vomiting occurred on the 5

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Child; Cystic Fibrosis; Humans; Minocycline; Pancreatitis; Tigecycline

To provide clinicians with an understanding of the comparative occurrence of tigecycline and pancreatitis, and to provide any clinically relevant characteristics that may be useful in identifying the patients at risk.. Retrospective cohort study.. Spontaneous reports in the United States Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) database generated between January 1997 and December 2010.. Sixty-two patients who experienced pancreatitis while receiving tigecycline therapy.. Disproportionality analysis with bayesian correction methodology was used to compare tigecycline with all other agents listed in the AERS. Disproportionality analysis uses an adverse event relative reporting ratio (RRR) to compare the occurrence of a specific adverse event with an index drug of interest to the occurrence of the same adverse event with similar agents or with all other FDA-approved prescription drugs. The value was considered meaningful if the 5th percentile of the distribution of the RRR (RRR(05)) was 2 or greater. Our review identified 62 potential cases of tigecyline-related pancreatitis. An RRR(05) score of 10.4, 10.38, and 2.87 was determined for tigecycline-related pancreatitis compared with all other agents, systemic antibiotics, and select tetracyclines listed in the AERS, respectively. In addition, a sex-based RRR(05) score was higher in women versus men (14.432 vs 3.125) when tigecycline was compared with all agents in the AERS.. Our analysis suggests a quantitative signal between tigecycline use and pancreatitis; however, given the limitations of our study, a cause-and-effect relationship cannot be inferred. Thus, additional rigorous scientific analyses are warranted to explore these findings.

Topics: Adult; Adverse Drug Reaction Reporting Systems; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cohort Studies; Female; Humans; Male; Middle Aged; Minocycline; Pancreatitis; Retrospective Studies; Tigecycline; United States; United States Food and Drug Administration

Tigecycline is a broad-spectrum antimicrobial agent structurally related to minocycline. Pancreatitis has been associated with the tetracycline class of antibiotics and concerns about tigecycline-induced acute pancreatitis have recently been raised. We describe a 69-year-old female who received tigecycline for treatment of a complicated skin and skin-structure infection. Following 7 days of tigecycline she developed severe abdominal pain and elevated pancreatic enzymes suggesting acute pancreatitis. According to the Naranjo adverse drug reaction probability scale, tigecycline was the probable cause of her acute pancreatitis. Clinicians should be aware of this potential adverse effect of tigecycline. We recommend that clinicians monitor patients for signs and symptoms of pancreatitis, including abdominal pain, during treatment with tigecycline.

Topics: Aged; Anti-Bacterial Agents; Female; Humans; Minocycline; Pancreatitis; Skin Diseases, Bacterial; Tigecycline

We describe a case of acute pancreatitis (AP) and hypofibrinogenemia associated with drug treatment with the aim to increase awareness of uncommon yet possibly life-threatening adverse reactions of tigecycline and furosemide.. A 75-year-old Chinese male was hospitalized for acute non-ST-elevation myocardial infarction and acute heart failure. The patient underwent successful percutaneous coronary intervention and MitraClip. Furosemide was taken since admission. Because. Clinicians should pay attention to clinical signs, symptoms, and pancreatic enzymes during tigecycline or furosemide treatment, especially when used in combination. In addition, regular monitoring of fibrinogen and platelet count during tigecycline treatment is suggested.

Topics: Acinetobacter baumannii; Acute Disease; Afibrinogenemia; Aged; Anti-Bacterial Agents; Fibrinogen; Furosemide; Humans; Male; Minocycline; Pancreatitis; Tigecycline

To assess the clinical experience of tigecycline-based salvage therapy in patients presenting with Bone and Joint Infections (BJI).. Multicenter retrospective cohort study in France and Turkey (2007-2014).. Thirty-six patients (age 58.2±17.8 years; 21 men) were included. The most frequently isolated bacteria were Enterobacteriaceae and staphylococci. Tigecycline (50mg BID, mainly in combination (69.4%), mean duration of 58 days) was indicated for multidrug resistance (90.6%) and/or previous antibiotic intolerance (36.1%), and/or as second- or third-line therapy (69.4%). Six patients (16.7%) experienced early treatment discontinuation for adverse event (4 severe vomiting, 1 pancreatitis, 1 asymptomatic lipase increase). Clinical success was observed in 23 of 30 assessable patients who completed the tigecycline therapy (mean follow-up: 54.1±57.7 weeks).. Prolonged tigecycline-based therapy could be an alternative in patients presenting with BJI requiring salvage therapy, especially if multidrug-resistant Enterobacteriaceae and/or staphylococci are involved.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthritis, Infectious; Cohort Studies; Drug Evaluation; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Follow-Up Studies; France; Humans; Male; Middle Aged; Minocycline; Osteitis; Pancreatitis; Retrospective Studies; Salvage Therapy; Tigecycline; Turkey; Vomiting

The knowledge about pathogens and their antibiotic susceptibility patterns is essential to select an appropriate antibiotic.. We investigated the microbiological profile in pancreatic and extrapancreatic infections, and antibiotic sensitivity pattern in patients with acute pancreatitis.. Of 556 patients with acute pancreatitis, only 189 developed bacterial infection; however, bacteremia was present in 42 patients (7.6%). Culture-proven infected pancreatic necrotic collection was present in 161 patients (29%). Escherichia coli and Klebsiella pneumoniae were the most common organisms. Among the bacterial infection cohort, 164 patients developed multidrug-resistant bacterial infection. Infection with multidrug-resistant bacteria, especially at multiple sites, increased mortality. Nearly 50% of patients (n = 94) acquired extremely drug-resistant bacterial infection at some time and emerged as key reason for prolonged hospital and intensive care unit stay. Colistin resistance and tigecycline resistance were documented in 2.1% and 17.2% of the specimens at admission and in 4.6% and 21% of specimens during the hospital stay. Of 556 patients, 102 patients developed fungal infection and 28 patients had only fungal infection without bacterial infection.. Colistin and tigecycline are best reserved as last-resort antibiotics. Fungal infection was found to be associated with increased mortality, median hospital stay, and intensive care unit stay.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Drug Resistance, Microbial; Female; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Minocycline; Mycoses; Outcome Assessment, Health Care; Pancreatitis; Tigecycline

Tigecycline is a broad spectrum antimicrobial agent, structurally similar to minocycline and that shares some tetracycline-related side effects. A case report is presented on a 68-year-old female who received tigecycline for a sepsis of unknown origin and who, in the following 5days, developed abdominal pain and elevated pancreatic enzymes, which suggested acute pancreatitis. After ruling out other origins, and according to the Naranjo adverse drug reaction probability scale, tigecycline was the probable cause of the acute pancreatitis, a complication that has been reported 5 times in the database of the Spanish pharmacosurveillance system since 2009. Close monitoring of abdominal signs and symptoms is recommended during treatment with tigecycline, since adverse effects affecting the digestive system are the most prevalent ones when using this drug.

Topics: Acute Disease; Aged; Anti-Bacterial Agents; Critical Care; Drug Substitution; Fatal Outcome; Female; Humans; Minocycline; Multiple Organ Failure; Pancreatitis; Sepsis; Tigecycline

The purpose of this case report is to increase awareness of tigecycline-associated pancreatitis, specifically in patients who may be predisposed to develop pancreatitis.. A 22-year-old male with cystic fibrosis developed acute bronchitis, with sputum cultures significant for Mycobacterium chelonae. He was started on tigecycline on two separate occasions, in each case developing pancreatitis as evidenced by symptomatology, elevated pancreatic enzymes and, in one case, by CT imaging. On both occasions, symptomatology improved and enzymes normalized after discontinuation of tigecycline.. Current literature including two recent review pieces is discussed. The unique aspects of the case are highlighted, including the particular risk of drug-associated pancreatitis in those with cystic fibrosis.. The results of this case, in the context of current literature, suggest that clinicians should be aware of the potential for pancreatitis when using tigecycline. Clinicians should be particularly mindful of this complication in patients with comorbidities that might increase the risk of pancreatitis above that of the general population.

Topics: Anti-Bacterial Agents; Bronchitis; Cystic Fibrosis; Disease Management; Humans; Male; Minocycline; Mycobacterium chelonae; Pancreatitis; Risk Adjustment; Tigecycline; Treatment Outcome; Young Adult

Topics: Aged; Anti-Bacterial Agents; Clinical Trials as Topic; Female; Humans; Incidence; Lipase; Long Term Adverse Effects; Male; Middle Aged; Minocycline; Pancreatitis; Retrospective Studies; Tigecycline

To examine the incidence of pancreatitis among subjects enrolled in the tigecycline clinical trial programme, summarize cases and examine concomitant use of other pancreatitis-causing medications.. Subject data from Phase 3 and 4 comparative tigecycline studies were included in the analysis; investigator-reported adverse events of 'pancreatitis', 'necrotizing pancreatitis' or 'pancreas disorder' were reviewed. Data were summarized and cases were reported. No statistical comparisons were made. The incidence of overall pancreatitis with 95% CIs was calculated. The Wilson score method was used to calculate CIs.. Nineteen subjects with investigator-determined pancreatitis were identified from the programme database, which included 3788 subjects treated with tigecycline and 3646 subjects treated with a comparator. There were 9 cases identified among the tigecycline-treated subjects [9 of 3788 (0.24%; 95% CI, 0.11-0.45)] and 10 cases among the comparator-treated subjects [10 of 3646 (0.27%; 95% CI, 0.13-0.50)]. The demographic characteristics of the subjects with pancreatitis were similar between treatment groups. The median duration of tigecycline therapy was 8.0 days compared with 11.0 days of comparator treatment. Concomitant or prior exposure to a Badalov class I medication was evident in the majority of subjects who developed pancreatitis. A numerically higher number of tigecycline-treated subjects were exposed to furosemide prior to the onset of pancreatitis than comparator-treated subjects.. Pancreatitis was uncommon in subjects treated with tigecycline, with an occurrence of <1%. Concomitant medications known to cause pancreatitis should be considered when prescribing tigecycline, but may not identify those at risk of developing pancreatitis.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Clinical Trials, Phase III as Topic; Clinical Trials, Phase IV as Topic; Female; Humans; Incidence; Male; Middle Aged; Minocycline; Pancreatitis; Tigecycline

Fusobacterium necrophorum is a non-sporulating anaerobic gram negative bacillus and has traditionally been associated with Lemierre's syndrome. The authors report a 34-year-old male who presented to the emergency department with a week's history of dull epigastirc pain. Significant medical history included chronic pancreatitis secondary to alcohol use. The patient had radiological evidence of acute on chronic pancreatitis with thrombosis of the portal vein and multiple intrahepatic abscesses. CT-guided drainage of left upper quadrant revealed fluid collection in the pancreatic bed. The fluid culture grew F necrophorum and the patient was treated with tigecycline for 4 weeks. The patient improved symptomatically and his follow-up computerised axial tomography scan 2 months later showed resolving liver abscess, cavernous transformation of the portal vein and stable findings of chronic pancreatitis. This could represent an infection of the peripancreatic tissue with F necrophorum further leading to pylephlebitis.

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Liver Abscess; Male; Minocycline; Pancreatitis; Portal Vein; Radiography; Tigecycline; Venous Thrombosis

Topics: Abdominal Pain; Anti-Bacterial Agents; Female; Humans; Middle Aged; Minocycline; Nausea; Pancreatitis; Tigecycline; Vomiting

Tigecycline is a new broad-spectrum antibiotic. Nausea and vomiting are its most common side-effects. We describe here a case of severe acute pancreatitis related to tigecycline in order to highlight the possible occurrence of this adverse event and to remind clinicians to measure the lipase rate if in any doubt.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Enterobacter cloacae; Enterobacteriaceae Infections; Fosfomycin; Humans; Lipase; Male; Minocycline; Osteitis; Pancreatitis; Tigecycline

Adequate antimicrobial therapy is of crucial importance for the survival of critically ill patients with severe nosocomial infections. Tigecycline is an important therapeutic option for the treatment of infections caused by multi-resistant Gram-positive and Gram-negative bacteria including vancomycin-resistant enterococci (VRE). A large randomised study (patients with APACHE-II-score >30 excluded/mean APACHE-II-score 6) demonstrated that tigecycline is not inferior to imipenem/cilastatin for treatment of complicated intra-abdominal infections. However, no case has been reported with microbiological eradication and clinical cure in a patient with septic shock due to peritonitis caused by VRE and treatment with tigecycline monotherapy. Clinical details of a patient suffering from postoperative peritonitis are presented. The patient developed severe septic shock after pancreatic surgery (multiple organ failure, APACHE-II-score 34). As the site of anastomotic leakage was very small and could not be exactly identified, irrigation-suction drains were placed followed by closed postoperative continuous lavage. The pathogen responsible was identified as a vancomycin-resistant Enterococcus faecium, therefore monotherapy with tigecycline was started which resulted in microbiological response and clinical cure. Tigecycline is a new therapeutic option for the treatment of intra-abdominal infections and from an economic point of view financially rewarding when used as monotherapy.

Topics: Anti-Bacterial Agents; APACHE; Enterococcus faecium; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Minocycline; Pancreatitis; Peritonitis; Shock, Septic; Tigecycline; Vancomycin Resistance

We report two cases of acute pancreatitis secondary to minocycline use in adults with cystic fibrosis (CF). This minocycline complication has not previously been reported. Given the increased use of minocycline in the adult CF population to treat resistant bacteria, awareness of this potential adverse effect is imperative. As both of these individuals with CF had class IV genotypes and pancreatic sufficiency, close observation is warranted in the future to determine if persons with pancreatic-sufficient CF are at an increased risk for minocycline-induced pancreatitis.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Cystic Fibrosis; Female; Humans; Minocycline; Pancreatitis; Respiratory Tract Infections

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Female; Humans; Middle Aged; Minocycline; Pancreatitis

Topics: Acne Vulgaris; Adolescent; Adult; Female; Hepatic Encephalopathy; Hepatorenal Syndrome; Humans; Liver Transplantation; Minocycline; Necrosis; Pancreatitis

Extracellular phospholipases A2 play an important role in articular and extra-articular inflammatory processes. Secretory non-pancreatic phospholipase A2 (PLA2) has been implicated in the pathogenesis of articular inflammation in rheumatoid arthritis, whereas pancreatic PLA2 contributes to the tissue damage associated with acute pancreatitis. Since in experimental models lipophilic tetracyclines such as minocycline and doxycycline are antiinflammatory, we examined their effects on PLA2 activity using two assay systems in vitro. We found that minocycline and to a lesser degree doxycycline were markedly inhibitory to both pancreatic and non-pancreatic PLA2. Using [14C]oleic acid labeled Escherichia coli membrane phospholipids as substrate, the IC50 values for minocycline and doxycycline were 3.6 x 10(-5) M (18 micrograms/mL) and 0.98 x 10(-4) M (47 micrograms/mL), respectively. In a scooting mode assay using the synthetic phospholipid 1-palmitoyl-2-(10-pyrenedecanoyl)-3-L-phosphatidylmethanol as substrate, IC50 values for minocycline were 5 microM (2.47 micrograms/mL) for non-pancreatic PLA2 and 8 microM (3.95 micrograms/mL) for pancreatic PLA2. Addition of excess calcium up to 50 mM did not reverse the inhibitory activity of tetracyclines. We conclude that lipophilic tetracyclines inhibit PLA2, probably by interaction with the substrate, and may be a useful adjunct in the therapy of inflammatory conditions in which PLA2 is implicated pathogenetically.

Topics: Animals; Doxycycline; Humans; Minocycline; Pancreatitis; Phospholipases A; Phospholipases A2; Recombinant Proteins; Swine; Synovial Fluid; Synovitis