Tigezyklin, a derivative of the tetracycline minocycline is the first available Glycylzyklin. Tigezykline inhibit protein synthesis by binding to the 30S ribosomal subunit. It is bacteriostatic. Pharmacology Tigezyklin is injected i.v. given. Tigezyklin has a large volume of distribution (> 12 l / kg) and also penetrates into the bone, lung, liver and kidney tissues. But because of its extensive distribution into tissues high blood levels are not maintained, which tigecycline is probably not a good choice for patients with bacteremia. A half-life of 36 hours easier once-daily dosing. The majority of the drug is excreted via bile and feces. Indications Tigezyklin is effective against many resistant bacteria, including those with resistance to tetracyclines. Tigezyklin is effective against many gram-positive bacteria, including methicillin-susceptible and methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae with decreased penicillin sensitivity, vancomycin-sensitive Enterococcus faecalis, vancomycin-resistant E. faecium and Listeria sp Many gram-negative bacteria such as multidrug-resistant Acinetobacter baumannii (generate including some strains extended-spectrum ?-lactamase [ESBL] and other strains were carbapenem-resistant, based on the production of a carbapenemase or metallo-?-lactamase), Stenotrophomonas maltophilia, Haemophilus influenzae, and most enterobacteria many atypical respiratory pathogens (chlamydia, Mycoplasma sp), Mycobacterium abscessus, M. fortuitum and anaerobes, including Bacteroides fragilis, Clostridium perfringens and C. difficile, it is not effective against Pseudomonas a eruginosa, Providencia sp, Morganella morganii, or Proteus sp. Tigecycline is indicated for the complicated skin and soft tissue infections Complicated intra-abdominal infections Community-acquired pneumonia Ene recent meta-analysis, however, showed that patients treated with tigecycline (particularly those treated for ventilator-associated pneumonia) had a higher mortality than patients given other antibiotics were given, resulting in a black box warning the FDA. In general, tigecycline infections with multi-drug resistant (MDR) organisms should be reserved for when other treatment options are more toxic or less effective. Due to its activity against C. difficile parenteral, tigecycline may be a useful antibiotic, when a patient requires a concurrent treatment against MDR infection and a C. difficile infection. Contraindications Tigezyklin is contraindicated in patients who have had an allergic reaction to it, and in children <8 years of use during pregnancy and lactation Tigezyklin is in pregnancy category D (there is evidence of human risk, but clinical benefits may increase the risk outweigh); it may - affect fetal bones and teeth - as tetracyclines. Whether Tigezyklin is excreted in breast milk and whether it is safe during breast-feeding is not known; However, it has limited oral bioavailability. Side effects Side effects include nausea, vomiting and diarrhea photosensitivity hepatotoxicity nausea and vomiting are common. Rises in serum amylase, the total bilirubin, PT and transaminases may occur in patients treated with Tigezyklin. From isolated cases of significant hepatic dysfunction and liver failure in patients treated with tigecycline was reported. Many of the adverse effects of Tigezyklin similar to those of tetracycline (z. B. sensitivity to light). Considerations Dosage The dose is adjusted in patients with liver dysfunction, but not in patients with renal impairment. Serum levels of warfarin may increase, but the INR does not seem to increase.