Tigecycline is efficacious in the treatment of complicated intra-abdominal infections

• Published in: International journal of surgery (London, England) Vol. 3; no. 1; pp. 35 - 47
• Main Authors: Fomin, Peter, Beuran, Mircea, Gradauskas, Audrius, Barauskas, Giedrius, Datsenko, Alexey, Dartois, Nathalie, Ellis-Grosse, Evelyn, Loh, Evan
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 2005
• Subjects: Complicated intra-abdominal infections; Efficacy; Glycylcycline; Imipenem/cilastatin; In vitro activity; Safety; Tigecycline; Complicated intra-abdominal infections; Imipenem/cilastatin; Glycylcycline; In vitro activity; Efficacy; Safety; Tigecycline
• ISSN: 1743-9191; 1743-9159
• DOI: 10.1016/j.ijsu.2005.03.011

Empiric treatment of complicated intra-abdominal infections (cIAI) represents a clinical challenge because of the diverse bacteriology and the emergence of bacterial resistance. The efficacy and safety of tigecycline (TGC), a first-in-class, expanded broad-spectrum glycylcycline antibiotic, were compared with imipenem/cilastatin (IMI/CIS) in patients with cIAI.
In this prospective, double-blind, phase 3, multinational trial, patients were randomly assigned to intravenous (IV) TGC (100mg initial dose, then 50mg every 12h) or IV IMI/CIS (500/500mg every 6h) for 5–14 days. Clinical response was assessed at the test-of-cure (TOC) visit (14–35 days after therapy) for microbiologically evaluable (ME) and microbiologically modified intent-to-treat (m-mITT) populations (co-primary efficacy endpoint populations in which cure/failure response rates were determined).
Of 817 mITT patients (i.e., received≥1 dose of study drug), 641 (78%) comprised the m-mITT cohort (322 TGC, 319 IMI/CIS) and 523 (64%) were ME (266 TGC, 256 IMI/CIS). Patients were predominantly white (88%) and male (59%) with a mean age of 49 years. The primary diagnoses for the mITT group were complicated appendicitis (41%), cholecystitis (22%), and intra-abdominal abscess (11%). For the ME population, clinical cure rates at TOC were 91.3% (242/265) for TGC versus 89.9% (232/258) for IMI/CIS (95% CI −4.0, 6.8; P<0.001). Corresponding clinical cure rates within the m-mITT population were 86.6% (279/322) for TGC versus 84.6% (270/319) for IMI/CIS (95% CI −3.7, 7.5; P<0.001 for noninferiority TGC versus IMI/CIS). The most commonly reported adverse events for TGC and IMI/CIS were nausea (17.6% TGC versus 13.3% IMI/CIS; P=0.100) and vomiting (12.6% TGC versus 9.2% IMI/CIS; P=0.144).
TGC is efficacious in the treatment of patients with cIAIs and TGC met per the protocol-specified statistical criteria for noninferiority to the comparator, IMI/CIS.