Tigecycline is unique glycylcycline class of semisynthetic antimicrobial agents developed for the treatment of polymicrobial infections caused by multidrug-resistant Gram-positive and Gram-negative pathogens. Tigecycline evades the main tetracycline resistance genetic mechanisms, such as tetracycline-specific efflux pump acquisition and ribosomal protection, via the addition of a glycyclamide moiety to the 9-position of minocycline. The use of the parenteral form of tigecycline is approved for complicated skin and skin structure infections (excluding diabetes foot infection), complicated intra-abdominal infections, and community-acquired bacterial pneumonia in adults. New evidence also suggests the effectiveness of tigecycline for the treatment of severe Clostridioides difficile infections. Tigecycline showed in vitro susceptibility to Coxiella spp., Rickettsia spp., and multidrug-resistant Neisseria gonnorrhoeae strains which indicate the possible use of tigecycline in the treatment of infections caused by these pathogens. Except for intrinsic, or often reported resistance in some Gram-negatives, tigecycline is effective against a wide range of multidrug-resistant nosocomial pathogens. Herein, we summarize the currently available data on tigecycline pharmacokinetics and pharmacodynamics, its mechanism of action, the epidemiology of tigecycline resistance, and its clinical effectiveness.

Department of Biochemistry Biophysics and Genetics Faculty of Medicine Mazandaran University of Medical Sciences Sari Iran

Department of Clinical Microbiology Iranshahr University of Medical Sciences Iranshahr Iran

Department of Laboratory Sciences Faculty of Paramedicine Golestan University of Medical Sciences P O Box 6939177143 Gorgan Sari Road Golestan Province Gorgan Iran

Department of Laboratory Sciences School of Allied Medical Sciences Ilam University of Medical sciences Ilam Iran

Department of Medical Microbiology 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Department of Microbiology and Virology Faculty of Medicine Mazandaran University of Medical Sciences Sari Iran

Department of Microbiology Faculty of Medicine Iran University of Medical Sciences Tehran Iran

Department of Prosthetic Dentistry Sechenov 1st Moscow State Medical University Russian Federation Trubetskaya st 8 2 119991 Moscow Russia

Laboratory Sciences Research Center Golestan University of Medical Sciences P O Box 6939177143 Gorgan Sari Road Golestan Province Gorgan Iran

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Tetracycline-modifying enzyme SmTetX from Stenotrophomonas maltophilia