Tigecycline
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tigecycline
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tigecycline FDA prescribing information boxed warning mortality 2025
Tigecycline is an intravenous glycylcycline antibiotic, structurally related to tetracyclines. It binds the 30S ribosomal subunit and inhibits bacterial protein synthesis.
- Usual adult dose: 100 mg IV loading dose, then 50 mg IV every 12 hours.
- FDA-approved uses: complicated intra-abdominal infection, complicated skin/skin-structure infection, and community-acquired bacterial pneumonia.
- Useful activity: many Gram-positive organisms including MRSA and VRE, many Gram-negative organisms, anaerobes, and atypicals.
- Important gaps: it does not reliably cover Pseudomonas aeruginosa, Proteus, Providencia, or Morganella species.
- Avoid as sole therapy for bacteremia or UTI: blood and urinary concentrations are relatively low.
- Major safety warning: it has an FDA boxed warning for an increased all-cause mortality signal compared with other antibiotics. Reserve it for situations where alternatives are unsuitable.
- Common adverse effects: nausea and vomiting, diarrhea, raised liver enzymes. Serious but less common effects include pancreatitis, hepatotoxicity, hypofibrinogenemia/coagulopathy, severe skin reactions, and C. difficile infection.
- Dose adjustment: none in renal impairment or dialysis. In severe hepatic impairment (Child-Pugh C), after the 100 mg loading dose, reduce maintenance to 25 mg IV every 12 hours.
- Pregnancy/children: use only when benefit outweighs risk; like other tetracycline-class drugs, it may affect fetal/child tooth and bone development.
The recent pharmacokinetic systematic review, PMID 41244714, supports substantial variability in tigecycline exposure, especially in critically ill patients, so specialist-led dosing decisions may be needed in severe infection.
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surgical site infection diagnosis wound drainage
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CDC surgical site infection signs purulent drainage incision guidance
Assuming the first image is earlier and the second image is later:
| Feature | First image | Second image | Interpretation |
|---|---|---|---|
| Drains | Two drains present | Drains removed, drain openings remain | Expected after removal, but sites need close observation |
| Main incision | Mostly well approximated with staples/sutures; small areas of pale-yellow material | Still closed overall, but there is more dark crusting and yellow-white material along parts of the line | Healing is not clearly improving |
| Drain sites | Tube entry sites not fully assessable | At least one drain site appears to have thick yellow-white discharge | Concerning for ongoing local wound infection or infected drainage-site tract |
| Redness/swelling | Some local dark discoloration and swelling | No dramatic spreading redness visible, but photograph alone cannot assess warmth/tenderness/deeper collection | Cannot rule out infection or a deeper collection |
Overall comparison
The incision remains largely approximated, with no obvious wide wound separation. However, the later photograph does not show a clean, dry healing incision. The yellow-white material along the incision and especially at the former drain sites is concerning for purulent discharge or slough, rather than uncomplicated healing. The wound should be reviewed by the operating surgical team today, particularly if this is new or increasing.
Surgical-site infection can present with purulent drainage, pain/tenderness, warmth, swelling, erythema, or wound separation. CDC SSI criteria include purulent drainage from an incision or drain as a concerning finding.
Seek urgent assessment now if any of these are present
- Fever, chills, fast heart rate, confusion, or feeling acutely unwell
- Increasing wound pain, warmth, redness, or swelling
- Foul-smelling or increasing yellow/green drainage
- The incision opens, staples loosen, or abdominal contents/bulge appear
- Reduced urine output, persistent vomiting, or severe abdominal pain
Until reviewed: keep the site clean and covered as advised by the surgeon, do not squeeze the drain openings or apply unprescribed creams, and ask whether a wound/drain-site culture and assessment for a collection are needed.
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