Tigecycline: what is it, and where should it be used?

Tigecycline is the first glycylcycline to be launched and is one of the very few new antimicrobials with activity against Gram-negative bacteria. It evades acquired efflux and target-mediated resistance to classical tetracyclines, but not chromosomal efflux in Proteeae and Pseudomonas. C-max is low, but tissue penetration is excellent and the compound has shown equivalence to imipenem/cilastatin in intra-abdominal infection and to vancomycin plus aztreonam in skin and skin structure infection. Tigecycline may prove particularly useful for treatment of surgical wound infections, where both gut organisms and MRSA are likely pathogens. It is also likely to find a role in the treatment of infections due to multiresistant pathogens, including Acinetobacter spp. and ESBL producers, as well as MRSA and enterococci.