Ticarcillin + Clavulanate

Indications

Ticarcillin + Clavulanate is used for: Septicemia, Lower Respiratory Infections, Bone & Joint Infections, Skin & Skin Structure Infections, Urinary Tract Infections, Intra-abdominal Infections, Gynecologic Infections

Adult Dose

Septicemia Indicated for septicemia caused by beta-lactamase–producing isolates of Klebsiella spp, Escherichia coli, Staphylococcus aureus, or Pseudomonas aeruginosa 3.1 g IV q4-6hr Lower Respiratory Infections Indicated for lower respiratory infections caused by beta-lactamase–producing isolates of S. aureus, Haemophilus influenzae, or Klebsiella spp 3.1 g IV q4-6hr Bone & Joint Infections Indicated for bone and joint infections caused by beta-lactamase–producing isolates of S. aureus 3.1 g IV q4-6hr Skin & Skin Structure Infections Indicated for skin and skin structure infections caused by beta-lactamase–producing isolates of S. aureus, Klebsiella spp, or E. coli 3.1 g IV q4-6hr Urinary Tract Infections Indicated for UTIs (complicated or uncomplicated) caused by beta-lactamase–producing isolates of E. coli, Klebsiella spp, P. aeruginosa (or other Pseudomonas spp), Citrobacter spp, Enterobacter cloacae, Serratia marcescens, or S. aureus 3.1 g IV q4-6hr Intra-abdominal Infections Indicated for peritonitis caused by beta-lactamase–producing isolates of E. coli, K. pneumoniae, or Bacteroides fragilis group 3.1 g IV q4-6hr Gynecologic Infections Indicated for endometritis caused by beta-lactamase–producing isolates of Prevotella melaninogenicus, Enterobacter spp (including E. cloacae), E. coli, Klebsiella pneumoniae, S. aureus, or Staphylococcus epidermidis Dose based on ticarcillin component Moderate: 200 mg/kg/day IV divided q4-6hr Severe: 300 mg/kg/day IV divided q4hr

Child Dose

Infections Dose based on ticarcillin component <3 months: Safety and efficacy not established <60 kg and >3 months: 200-300 mg/kg/day IV divided q4-6hr; not to exceed 24 g/day >60 kg: As adults; 3.1 g IV q4-6hr Neonates (<7 days old, <2 kg) OR (>7 days old, <1.2 kg): 150 mg/kg/day IV divided q12hr (<7 days old, >2 kg) OR (>7 days old, 1.2-2 kg): 225 mg/kg/day IV divided q8hr >7 days old, >2 kg: 300 mg/kg/day IV divided q8hr Cystic Fibrosis 300-600 mg/kg/day IV/IM divided q6hr; not to exceed 24 g/day

Renal Dose

Renal Impairment Load: 3.1 g IV, THEN reduce maintenance dose based on creatinine clearance CrCl 30-60 mL/min: 2 g q4hr CrCl 10-30 mL/min: 2 g q8hr CrCl <10 mL/min: 2 g q12hr CrCl<10 mL/min & hepatic impairment: 2 g qDay Peritoneal dialysis: 3 g q12hr Hemodialysis: 2 g q12hr; supplement with 3 g after each dialysis session

Administration

IV Preparation Reconstitute 3.1 g vial with 13 mL SWI or NS; final concentration 200 mg/6.7 mg/mL For intermittent IV infusion, further dilute to 10-100 mg/mL (ticarcillin component with compatible IV solution Bulk vial 30 g/1 g Not for direct infusion Reconstitute with 76 mL SWI or NS; final concentration 300 mg/10 mg/mL Further dilute before administration to 10-100 mg/mL (ticarcillin component) IV Administration Intermittent IV infusion over 30 min Administer 1 hr apart from aminoglycosides

Contra Indications

Allergy to penicillins or other beta-lactam antibacterials (eg, cephalosporins, imipenem)

Precautions

Serious and occasionally fatal hypersensitivity reactions reported Clostridium difficile associated diarrhea reported with use of nearly all antibacterial agents, including ticarcillin Seizures reported when dose exceeded, especially in presence of renal impairment Risk of bleeding complication Potential for microbial overgrowth or bacterial resistance Laboratory tests: High urine concentrations of ticarcillin may produce false-positive protein reactions; clavulanate may cause a nonspecific binding of IgG and albumin by RBC leading to a false-positive Coombs test Hypokalemia reported Monitor renal, hepatic, and hematologic function

Pregnancy-Lactation

Pregnancy Category: B Lactation: excreted into breast milk at low concentrations; use caution

Interactions

Adverse Effects

Side effects of Ticarcillin + Clavulanate : 1-10% Rash Nausea Diarrhea Phlebitis at injection site Increased eosinophils Increased AST Increased ALT

Mechanism of Action

Inhibits cell wall biosynthesis by binding to 1 of more penicillin binding proteins, which subsequently inhibits bacterial cell wall synthesis and has a bactericidal effect