On March 20, the FDA approved a new indication for tigecycline intravenous infusion (Tygacil, Wyeth Pharmaceuticals, Inc), allowing its use for the treatment of community-acquired bacterial pneumonia (CABP) caused by Streptococcus pneumonia (penicillin-susceptible isolates), including cases with concurrent bacteremia, Haemophilus influenzae (beta-lactamase negative isolates), and Legionella pneumophila.
These approvals for specific pathogens don’t make a whole lot of sense because initial antibiotic selection is seldom possible on the basis of microbiologic data, but that’s the way the FDA works.
Given its excellent tissue penetration and anti-MRSA activity it’s certain to be used “off label” for MRSA pneumonia or suspected MRSA pneumonia although that role needs better definition. Vancomycin and linezolid remain the alternatives of choice for MRSA pneumonia although they leave much to be desired. A recent review of MRSA pneumonia in Current Opinion in Pulmonary Medicine said:
Tigecycline is a glycylcycline antimicrobial, a new analogue of tetracycline that has in-vitro activity against MRSA. It is bacteriostatic and rapidly distributed with extensive tissue penetration. The drug is approved for complicated intraabdominal infections and SSTIs. In-vitro data suggest that the drug was four-fold more potent than vancomycin and eight-fold more potent than linezolid against respiratory pathogens, including MRSA. Clinical data are needed to define its role in the treatment of CAP and HAP due to MRSA.