PMID- 21685488
OWN - NLM
STAT- MEDLINE
DCOM- 20111014
LR  - 20220317
IS  - 1460-2091 (Electronic)
IS  - 0305-7453 (Linking)
VI  - 66
IP  - 9
DP  - 2011 Sep
TI  - Efficacy and safety of tigecycline: a systematic review and meta-analysis.
PG  - 1963-71
LID - 10.1093/jac/dkr242 [doi]
AB  - BACKGROUND: Tigecycline is a novel glycylcycline that exhibits broad-spectrum 
      antibacterial activity. Recently, the US FDA issued a warning concerning 
      increased mortality with tigecycline in randomized controlled trials (RCTs). 
      METHODS: We conducted a systematic review and meta-analysis of RCTs that compared 
      tigecycline with any other antibiotic regimen for the treatment of any infection. 
      A comprehensive search, without publication status or other restrictions, was 
      conducted. The primary outcome was overall 30 day mortality. The secondary 
      outcome included clinical and microbiological failure, superinfections and 
      adverse events (AEs). The trials' risks of bias and their effects on results were 
      assessed. Two reviewers independently extracted the data. Individual trials' 
      relative risks (RRs) were pooled using a fixed effect meta-analysis. RESULTS: 
      Fifteen trials (7654 patients) were included. Overall mortality was higher with 
      tigecycline compared with other regimens [RR 1.29, 95% confidence interval (CI) 
      1.02-1.64, without heterogeneity]. The type of infection assessed and the trials' 
      reported risks of bias did not affect this result. Clinical failure was 
      significantly higher with tigecycline (RR 1.16, 95% CI 1.06-1.27) and 
      non-statistically significant higher rates of microbiological failure were 
      demonstrated (RR 1.13, 95% CI 0.99-1.30). Development of septic shock was 
      significantly more frequent with tigecycline (RR 7.01, 95% CI 1.27-38.66). 
      Superinfections were significantly more common with tigecycline and so were AEs, 
      including all AEs and AEs requiring discontinuation. CONCLUSIONS: In the light of 
      the increased mortality, probably explained by decreased clinical and 
      microbiological efficacy, clinicians should avoid tigecycline monotherapy in the 
      treatment of severe infections and reserve it as a last-resort drug.
FAU - Yahav, Dafna
AU  - Yahav D
AD  - Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, 
      Israel. dafna.yahav@gmail.com
FAU - Lador, Adi
AU  - Lador A
FAU - Paul, Mical
AU  - Paul M
FAU - Leibovici, Leonard
AU  - Leibovici L
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20110618
PL  - England
TA  - J Antimicrob Chemother
JT  - The Journal of antimicrobial chemotherapy
JID - 7513617
RN  - 0 (Anti-Bacterial Agents)
RN  - 70JE2N95KR (Tigecycline)
RN  - FYY3R43WGO (Minocycline)
SB  - IM
CIN - J Antimicrob Chemother. 2011 Dec;66(12):2892-3; author reply 2895-6. PMID: 
      21862475
CIN - J Antimicrob Chemother. 2011 Dec;66(12):2893-5; author reply 2895-6. PMID: 
      21921075
MH  - Anti-Bacterial Agents/*adverse effects/*therapeutic use
MH  - Bacterial Infections/*drug therapy/microbiology/mortality
MH  - Confidence Intervals
MH  - Humans
MH  - Minocycline/adverse effects/*analogs & derivatives/therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Shock, Septic/etiology
MH  - Tigecycline
MH  - Treatment Failure
MH  - Treatment Outcome
EDAT- 2011/06/21 06:00
MHDA- 2011/10/15 06:00
CRDT- 2011/06/21 06:00
PHST- 2011/06/21 06:00 [entrez]
PHST- 2011/06/21 06:00 [pubmed]
PHST- 2011/10/15 06:00 [medline]
AID - dkr242 [pii]
AID - 10.1093/jac/dkr242 [doi]
PST - ppublish
SO  - J Antimicrob Chemother. 2011 Sep;66(9):1963-71. doi: 10.1093/jac/dkr242. Epub 
      2011 Jun 18.