Pharmacokinetics-pharmacodynamics of tigecycline in patients with community-acquired pneumonia

Antimicrob Agents Chemother. 2012 Jan;56(1):130-6. doi: 10.1128/AAC.00277-10. Epub 2011 Oct 3.

Abstract

Exposure-response analyses for efficacy and safety were performed for tigecycline-treated patients suffering from community-acquired pneumonia. Data were collected from two randomized, controlled clinical trials in which patients were administered a 100-mg loading dose followed by 50 mg of tigecycline every 12 h. A categorical endpoint, success or failure, 7 to 23 days after the end of therapy (test of cure) and a continuous endpoint, time to fever resolution, were evaluated for exposure-response analyses for efficacy. Nausea/vomiting, diarrhea, headache, and changes in blood urea nitrogen concentration (BUN) and total bilirubin were evaluated for exposure-response analyses for safety. For efficacy, ratios of the free-drug area under the concentration-time curve at 24 h to the MIC of the pathogen (fAUC(0-24):MIC) of ≥12.8 were associated with a faster time to fever resolution; patients with lower drug exposures had a slower time to fever resolution (P = 0.05). For safety, a multivariable logistic regression model demonstrated that a tigecycline AUC above a threshold of 6.87 mg · hr/liter (P = 0.004) and female sex were predictive of the occurrence of nausea and/or vomiting (P = 0.004). Although statistically significant, the linear relationship between tigecycline exposure and maximum change from baseline in total bilirubin is unlikely to be clinically significant.

Publication types

  • Clinical Trial, Phase III
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / blood
  • Anti-Bacterial Agents / pharmacokinetics
  • Anti-Bacterial Agents / pharmacology*
  • Area Under Curve
  • Bilirubin / blood
  • Blood Urea Nitrogen
  • Community-Acquired Infections / blood
  • Community-Acquired Infections / drug therapy*
  • Community-Acquired Infections / microbiology
  • Double-Blind Method
  • Drug Administration Schedule
  • Female
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Minocycline / analogs & derivatives*
  • Minocycline / blood
  • Minocycline / pharmacokinetics
  • Minocycline / pharmacology
  • Pneumonia, Bacterial / blood
  • Pneumonia, Bacterial / drug therapy*
  • Pneumonia, Bacterial / microbiology
  • Regression Analysis
  • Sex Factors
  • Streptococcus pneumoniae / drug effects*
  • Streptococcus pneumoniae / growth & development
  • Tigecycline
  • Treatment Outcome
  • United States

Substances

  • Anti-Bacterial Agents
  • Tigecycline
  • Minocycline
  • Bilirubin