Tigecycline in CR-Kp Associated VAP with High Dose vs. Conventional Dose: Adverse Events are the Key Superiority-determiner

Background: Multi-drug Resistant (MDR) pathogen Carbapenem-Resistance Klebsiella pneumonia (CR-Kp) associated Ventilator-Associated Pneumonia (VAP) is a serious infectious disease and tigecycline with high or conventional dose, is one of the last resort potential antibiotics for its treatment. Objective: The major objective of this study was to evaluate the key role of adverse events in preferring the better dosing option of tigecycline. Methods: Total 45 middle-aged MDR-CR-Kp associated VAP patients and treated with high (200 mg/day) and conventional dose (100 mg/day) of tigecycline (intravenous) distributed into two groups. Group-wise microbiological eradication rate, secondary infection rate, 30 days mortality rate and dose-related adverse events were analyzed and compared, accordingly. Result: After 5 days, highest microbiological eradication was observed in HD-group (79.17%) than CD-group (47.62%) with low rate of secondary infections (8.33% versus 33.33%). The 30 days mortality rate was relatively higher in HD-group (45.83% versus 38.10%). Severity and frequency of high-dose associated adverse events were higher in HD-group at all parameters than CD-group (elevation of ALT: 33.33%/23.81%; AST: 41.67%/28.57%; bilirubin: 37.50%/19.05%; reduction of blood pH: 45.83%/9.52%, respectively). Conclusion: High dose of tigecycline showed relatively higher therapeutic response in MDR-CR-Kp associated VAP treatment than conventional dose but, with increased rate of adverse events, which questioned its practice.