Exposure-response analyses of tigecycline efficacy in patients with complicated skin and skin-structure infections

Antimicrob Agents Chemother. 2007 Jun;51(6):1939-45. doi: 10.1128/AAC.01084-06. Epub 2007 Mar 12.

Abstract

Exposure-response analyses were performed for the microbiological and clinical efficacy of tigecycline in the treatment of complicated skin and skin-structure infections, where Staphylococcus aureus and streptococci are the predominant pathogens. A prospective method was developed to create homogeneous patient populations for PK-PD analyses. Evaluable patients from three clinical trials were pooled for analysis. Patients received a tigecycline 100-mg loading dose/50 mg every 12 h or a 50-mg loading dose/25 mg every 12 h. At the test-of-cure visit, microbiologic and clinical responses were evaluated. Patients were prospectively evaluated and classified into cohorts based on baseline pathogens: S. aureus only (cohort 1), monomicrobial S. aureus or streptococci (cohort 2), two gram-positive pathogens (cohort 3), polymicrobial (cohort 4), or other monomicrobial infections (cohort 5). A prospective procedure for combining cohorts was used to increase the sample size. Logistic regression evaluated steady-state 24-h area under the concentration-time curve (AUC(24))/MIC ratio as a predictor of response, and classification and regression tree (CART) analyses were utilized to determine AUC/MIC breakpoints. Analysis began with pooled cohorts 2 and 3, the focus of these analyses, and included 35 patients with 40 S. aureus and/or streptococcal pathogens. CART analyses identified a significant AUC/MIC breakpoint of 17.9 (P = 0.0001 for microbiological response and P = 0.0376 for clinical response). The continuous AUC/MIC ratio was predictive of microbiological response based on sample size (P = 0.0563). Analysis of all pathogens combined decreased the ability to detect exposure-response relationships. The prospective approach of creating homogeneous populations based on S. aureus and streptococci pathogens was critical for identifying exposure-response relationships.

Publication types

  • Clinical Trial, Phase II
  • Clinical Trial, Phase III
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents* / administration & dosage
  • Anti-Bacterial Agents* / pharmacokinetics
  • Anti-Bacterial Agents* / therapeutic use
  • Area Under Curve
  • Double-Blind Method
  • Female
  • Humans
  • Logistic Models
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Minocycline / administration & dosage
  • Minocycline / analogs & derivatives*
  • Minocycline / pharmacokinetics
  • Minocycline / therapeutic use
  • Skin Diseases, Bacterial / drug therapy*
  • Skin Diseases, Bacterial / microbiology
  • Staphylococcal Skin Infections / drug therapy
  • Staphylococcal Skin Infections / microbiology
  • Staphylococcus aureus / drug effects*
  • Streptococcal Infections / drug therapy
  • Streptococcal Infections / microbiology
  • Streptococcus / classification
  • Streptococcus / drug effects*
  • Tigecycline
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Tigecycline
  • Minocycline