Tigecycline is an antibiotic used to treat a number of bacterial infections.

It is a glycylcycline that is administered intravenously. It was developed in response to the growing rate of antibiotic resistance in bacteria such as Staphylococcus aureus, Acinetobacter baumannii, and Escherichia coli.

As a tetracycline derivative antibiotic, its structural modifications has expanded its therapeutic activity to include Gram-positive and Gram-negative organisms, including those of multi-drug resistance.

Tigecycline is marketed by Pfizer under the brand name Tygacil. It was given a U.S. Food and Drug Administration (FDA) fast-track approval and was approved on June 17, 2005.

It can only be used intravenously which is also difficult to pass blood brain barrier (BBB). So, it will be a breakthrough if intraventricular (IVT) tigecycline is used in the clinical therapy.

Fang et al. described a case of a 50-year-old male worker whose clinical futures were high fever and cerebral rigidity after neurosurgery.

The patient was treated with IVT tigecycline.

The symptoms of intracranial infection disappeared. The temperature of this patient decreased to normal and cerebral rigidity disappeared. The cerebrospinal fluid culture became negative, with normal levels of white blood cell, glucose and chlorine.

IVT tigecycline therapy maybe effective to intracranial infection with XDR A baumannii. However, more studies will further demonstrate the therapeutic values of IVT tigecycline to intracranial infection, and not only restricted to A baumannii infections ¹⁾.

Shrestha et al report a case of MDR Acinetobacter ventriculitis treated with intravenous and intraventricular colistin together with intravenous tigecycline. The patient developed nephrotoxicity and poor neurological outcome despite microbiological cure. Careful implementation of bundle of measures to minimize EVD-associated ventriculitis is valuable ²⁾.

A case of a 42-year-old male patient affected by low-grade ependymoma who developed AB-MDR post-neurosurgical ventriculitis. Initially, because of in vitro susceptibility, De Pascale et al used a combination of intravenous colistin and tigecycline. This treatment resulted in the improvement of the patient's initial condition. However, soon after, the infection relapsed; tigecycline was stopped and treatment with intrathecal colistin was initiated. Cure was achieved by continuing this treatment for approximately three weeks, without adverse effects ³⁾.