Standard dose could be better! A multicenter study of tigecycline in patients with liver failure

High-dose (HD) tigecycline is often required for severe multidrug-resistant gram-negative infections in liver failure patients, despite package recommendations to halve the dose for those with severe liver impairment. This study evaluated the efficacy and safety of different tigecycline doses in this population. A retrospective cohort of 192 patients with Child-Pugh grade C liver failure was divided into label-dose (LD), standard-dose (SD), and HD groups. Primary and secondary outcomes included microbial eradication, mortality, and adverse effects. The SD group achieved higher microbial eradication than LD, with comparable efficacy to HD but fewer adverse events, such as fibrinogen requirements. High-dose treatment increased mortality risk (Hazard Ratio: 1.85, <i>p</i> = 0.062). Optimal microbial eradication and minimized adverse effects occurred with the SD group at 7 days of treatment. Standard-dose tigecycline offers a balanced approach to microbial eradication and safety, making it preferable in liver failure patients.