Why carry out this study?

Resistance to carbapenems has been steadily increasing in many bacteria causing nosocomial infections. Therefore, antibiotics like tigecycline and colistin are considered as the last resort against some of those multidrug-resistant bacteria.

However, some studies have indicated that using the standard dose of tigecycline might result in worse clinical outcomes compared with other antibiotics. As a result, applying the higher dose of tigecycline has been a common clinical practice. Despite such widespread practice, studies assessing the effect of high dose tigecycline on severe infections are still limited and remain controversial.

What was learned from the study?

High dose tigecycline (200 mg loading dose, 100 mg q12h) had better outcomes (lower all-cause mortality, higher clinical cure and microbiology eradication rate) and comparable adverse events compared with standard dose tigecycline (100 mg loading dose, 50 mg q12h) and other antibiotics.

High dose tigecycline is recommended if a tigecycline-containing regimen is the clinical choice for severe infections, especially those with multidrug-resistant bacterial infections.

Well-designed randomised controlled trials with larger sample size are warranted to confirm the effectiveness and safety of high dose tigecycline in the treatment of severe infections.