Are outcomes WORSE with tigecycline (Tygacil) compared with other antibiotics? New evidence is saying "yes".. For further information, see the September 2013 FDA update regarding the increased risk of death with Tygacil: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-increased-risk-death-iv-antibacterial-tygacil-tigecycline. Initial studies suggested that tigecycline is comparable to vancomycin plus aztreonam for skin infections, imipenem for intra-abdominal infections and levofloxacin for community-acquired pneumonia. But many of these patients weren't seriously ill. In 2010, FDA warned that tigecycline may not be as effective as other antibiotics for treating some infections, especially ventilator-associated pneumonia. But analyses have been conflicting.
Now there's new evidence that supports FDA's warning. The risk of death and treatment failure is higher with tigecycline than other antibiotics. This seems to be true for any kind of infection, approved indication or not. The relative risk of death with tigecycline is about 30% higher compared to other antibiotics. This translates to one more death for every 143 patients treated with tigecycline. The relative risk of treatment failure is about 12% higher, or one more for every 34 patients treated with tigecycline.
Experts think the higher mortality is due to treatment failure, not adverse effects. Tigecycline blood levels are low compared with tissue levels. This could reduce efficacy in more serious infections. Save tigecycline for less serious infections when there aren't other good options. Continue to avoid using it for sepsis, ventilator-associated pneumonia, or any time adequate blood levels are critical.
REFERENCES
Research, C. for D.E. and (2018). FDA Drug Safety Communication: Increased risk of death with Tygacil (tigecycline) compared to other antibiotics used to treat similar infections. FDA. [online] Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-increased-risk-death-tygacil-tigecycline-compared-other-antibiotics
Prasad P, Sun J, Danner RL, Natanson C. Excess deaths associated with tigecycline after approval based on noninferiority trials. Clin Infect Dis. 2012 Jun;54(12):1699-709. Available at: https://pubmed.ncbi.nlm.nih.gov/22467668