Carbenicillin Indanyl Sodium
Class: Extended-spectrum Penicillins
Chemical Name: [2S - (2α,5α,6β)] - 6 - [[3 - [(2,3 - dihydro - 1H - inden - 5 - yl)oxy] - 1,3 - dioxo - 2 - phenylpropyl] - amino] - 3,3 - dimethyl - 7 - oxo - 4 - thia - 1 - azabicyclo[3.2.O]heptane - 2 - carboxylic acid monosodium salt
CAS Number: 26605-69-6
Uses for Carbenicillin Indanyl Sodium
Urinary Tract Infections (UTIs)
Treatment of acute or chronic infections of the upper and lower urinary tract or for asymptomatic bacteriuria caused by susceptible enterococci, Enterobacter, Escherichia coli, Morganella morganii, Proteus mirabilis, P. vulgaris, Providencia rettgeri, Pseudomonas, or enterococci.1 2 4 12 27 28 29 30 33
Not a drug of choice for these UTIs.2 4 33 Because only low carbenicillin concentrations are attained in urine and renal parenchyma in patients with severe renal impairment, the drug may be ineffective for treatment of UTIs in patients with Clcr <10 mL/minute.11
Carbenicillin Indanyl Sodium Dosage and Administration
Available as carbenicillin indanyl sodium; dosage expressed in terms of carbenicillin.1
Urinary Tract Infections (UTIs)
UTIs Caused by Enterobacter, E. coli, or ProteusOral
UTIs Caused by Pseudomonas or EnterococcusOral
No dosage adjustments except those related to renal impairment. (See Renal Impairment under Dosage and Administration.)
Cautions for Carbenicillin Indanyl Sodium
Known hypersensitivity to any penicillin.1
Serious and occasionally fatal hypersensitivity reactions (including anaphylaxis) reported with penicillins.1 Anaphylaxis occurs most frequently with parenteral penicillins but has occurred with oral penicillins.1
Prior to initiation of therapy, make careful inquiry regarding previous hypersensitivity reactions to penicillins, cephalosporins, or other drugs.1 Partial cross-allergenicity occurs among penicillins and other β-lactam antibiotics including cephalosporins and cephamycins.1 19 20 21 22
If hypersensitivity reaction occurs, discontinue immediately and institute appropriate therapy as indicated (e.g., epinephrine, corticosteroids, maintenance of an adequate airway and oxygen).1
Periodically assess organ system functions, including renal, hepatic, and hematopoietic, during prolonged therapy.1
Selection and Use of Anti-infectives
To reduce development of drug-resistant bacteria and maintain effectiveness of carbenicillin and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.a
When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.a In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.a
Coombs’ Test Results
Each tablet of carbenicillin indanyl sodium containing 382 mg of carbenicillin contains 23 mg of sodium.1
Safety and efficacy not established in pediatric patients.1
Serum concentrations of extended-spectrum penicillins may be increased and half-life prolonged in patients with hepatic impairment.b
Dosage adjustment may be necessary in patients with Clcr 10–20 mL/minute to prevent accumulation of the drug.1
Should not be used in patients with severe renal impairment (i.e., Clcr <10 mL/minute) since these patients will not achieve therapeutic concentrations in urine.1
Common Adverse Effects
Interactions for Carbenicillin Indanyl Sodium
Specific Drugs and Laboratory Tests
Drug or Test
Some in vitro evidence of additive or synergistic antibacterial effects with extended-spectrum penicillins against some Enterobacteriaceae or Pseudomonas aeruginosa;b synergism is unpredictable and antagonism has been reported rarelyb
Some in vitro evidence of additive or partially synergistic antibacterial effects with other β-lactam antibiotics (e.g., cephalosporins, cephamycins);b synergism is unpredictable and indifference or antagonism has been reported more frequently than synergismb
Possible decreased renal clearance of methotrexate and increased risk of methotrexate adverse effectsb
Patients receiving penicillins and methotrexate concomitantly should be monitored carefullyb
Tests for glucose
Possible false-positive reactions in urine glucose tests using Clinitest, Benedict’s solution, or Fehling’s solutionb
Use glucose tests based on enzymatic glucose oxidase reactions (e.g., Clinistix, Tes-Tape)b
Tests for uric acid
Carbenicillin Indanyl Sodium Pharmacokinetics
After absorption, carbenicillin indanyl sodium is rapidly and completely hydrolyzed to carbenicillin and indanol.2 5 8 13 Peak serum concentrations of carbenicillin generally attained within 0.5–2 hours.1 12 14 15
Plasma Protein Binding
Serum concentrations of extended-spectrum penicillins may be increased and half-life prolonged in patients with hepatic impairment.b In patients with both renal and hepatic impairment, serum half-life of carbenicillin may range up to 32 hours.b
Serum half-life ranges from 9.4–23.4 hours in patients with Clcr <10 mL/minute per 1.73 m2.b
Actions and Spectrum
Based on spectrum of activity, classified as an extended-spectrum penicillin.3 6 More active against gram-negative bacilli than natural penicillins, penicillinase-resistant penicillins, and aminopenicillins.b
Available as the sodium salt of the indanyl ester of carbenicillin.1 8 Carbenicillin indanyl sodium is rapidly hydrolyzed to carbenicillin in vivo;1 2 3 5 6 8 13 18 the antibacterial activity of the ester is not clinically important.2 6 18
Gram-negative aerobes: active in vitro against Enterobacter, Escherichia coli, Proteus mirabilis, P. vulgaris, Morganella morganii, Providencia rettgeri, and Pseudomonas.1 b Klebsiella usually are resistant;1 b resistance has been reported in Pseudomonas.1 b
Complete cross-resistance generally occurs between carbenicillin and ticarcillin.b
Advice to Patients
Advise patients that antibacterials (including carbenicillin) should only be used to treat bacterial infections and not used to treat viral infections (e.g., the common cold).a
Importance of completing full course of therapy, even if feeling better after a few days.a
Advise patients that skipping doses or not completing the full course of therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with carbenicillin or other antibacterials in the future.a
Importance of discontinuing therapy and informing clinician if an allergic reaction occurs.a
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.1
Importance of women informing clinician if they are or plan to become pregnant or plan to breast-feed.1
Importance of informing patients of other important precautionary information. (See Cautions.)
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
382 mg (of carbenicillin)
This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.
The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.
AHFS Drug Information. © Copyright, 1959-2013, Selected Revisions May 1, 2004. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
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a. Pfizer. Geocillin (carbenicillin indanyl sodium) tablets prescribing information. New York, NY; 2003 Sept.
b. AHFS Drug Information 2004. McEvoy GK, ed. Extended-spectrum Penicillins General Statement. American Society of Health-System Pharmacists; 2004:341-9.