Ticarcillin

Indications

Ticarcillin is used for: Severe Gram-negative infections, Skin infections, Septicaemia, Bone and joint infections, Peritonitis, Urinary tract infections,

Adult Dose

Intravenous Severe Gram-negative infections, Skin infections, Septicaemia, Bone and joint infections, Peritonitis Adult: 200-300 mg/kg daily by infusion in divided doses every 4 or 6 hr. Parenteral Uncomplicated urinary tract infections Adult: 1 g IM/slow IV Inj every 6 hr. Complicated urinary tract infections Adult: 150-200 mg/kg daily by IV infusion in divided doses every 4 or 6 hr.

Child Dose

Intravenous Severe Gram-negative infections, Skin infections, Septicaemia, Bone and joint infections, Peritonitis Child: 200-300 mg/kg by infusion in divided doses every 4 or 6 hr. Parenteral Uncomplicated urinary tract infections Child: 50-100 mg/kg in divided doses every 6-8 hr. Do not inject >2 g into each IM site. Incompatibility: Incompatible with aminoglycosides. Complicated urinary tract infections Child: 150-200 mg/kg daily by IV infusion in divided doses every 4 or 6 hr.

Renal Dose

Renal impairment: Peritoneal dialysis patients: 3 g every 12 hr; haemodialysis patients: 2 g every 12 hr plus an additional dose of 3 g after each dialysis session. CrCl (ml/min) Dosage Recommendation 30-60 Initial IV loading dose of 3 g, followed by 2 g every 4 hr. 10-30 Initial IV loading dose of 3 g, followed by 2 g every 8 hr. <10 Initial IV loading dose of 3 g, followed by 2 g every 12 hr (or 1 g IM every 6 hr). <10 with hepatic impairment Initial IV loading dose of 3 g, followed by 2 g IV every 24 hr or 1 g IM every 12 hr.

Administration

Contra Indications

Hypersensitivity to penicillins.

Precautions

Restricted sodium diet. Very high doses in poor renal function (risk of neurotoxicity) or heart failure. Avoid contact, skin sensitisation may occur. Monitor electrolyte concentrations, renal, hepatic and haematological status during prolonged and high dose therapy. Jarisch-Herxheimer reaction may be seen in spirochete infections particularly syphilis; avoid intrathecal route.

Pregnancy-Lactation

Interactions

Probenecid decreases clearance of ticarcillin. Increased bleeding risk with warfarin, acenocoumarol. Possible increase in ciclosporin, methotrexate levels with concurrent use. Possible contraceptive failure with combined oral contraceptives.

Adverse Effects

Side effects of Ticarcillin : Pain at the inj site and phlebitis; electrolyte disturbances (hypokalaemia or hypernatraemia); dose-dependent coagulation defect; purpura and haemorrhage; hypersensitivity reactions; haemolytic anaemia; interstitial nephritis; neutropenia; CNS toxicity including convulsions; diarrhoea; pseudomembranous colitis. Haemorrhagic cystitis especially in cystic fibrosis patients. Potentially Fatal: Anaphylaxis.

Mechanism of Action

Ticarcillin is bactericidal through inhibition of the final cross-linking stage of peptidoglycan production by binding and inactivating transpeptidases thus inhibiting bacterial cell wall synthesis. It is active against gram-positive bacteria, gram-negative cocci, Pseudomonas aeruginosa, spirochetes, actinomycetes and has an extended spectrum of gram-negative bacteria compared to benzylpenicillin.