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Ticarcillin / Clavulanate Potassium
Pronunciation: TIE-car-sill-in/CLAV-you-luh-nate poe-TASS-ee-uhm
Class: Extended-spectrum penicillin
- Powder for injection 3 g ticarcillin (as disodium) and 0.1 g clavulanic acid (as potassium) (contains 4.75 mEq sodium and 0.15 mEq potassium/g)
- Injection solution 3 g ticarcillin (as disodium) and 0.1 g clavulanic acid (as potassium) per 100 mL (contains 18.7 mEq sodium and 0.5 mEq potassium per 100 mL)
Ticarcillin inhibits bacterial cell wall mucopeptide synthesis. Clavulanate lactamase enzymes commonly found in microorganisms resistant to ticarcillin.
T max is achieved immediately after completion of the infusion. C max is 330 mcg/mL (ticarcillin) and 8 to 16 mcg/mL (clavulanic acid). AUC is about 485 mcg•h/mL and about 8.2 mcg•h/mL for ticarcillin and clavulanic acid, respectively.
The drugs are not highly protein bound (approximately 45% and 9% for ticarcillin and clavulanic acid, respectively). Ticarcillin/Clavulanate is detected in tissues and interstitial fluid following IV administration. Penetration into bile and pleural fluid has been demonstrated.
Serum t ½ is about 1.1 h. Approximately 60% to 70% of ticarcillin and approximately 35% to 45% of clavulanic acid are excreted unchanged in urine during the first 6 h after a single dose.
Special PopulationsRenal Function Impairment
The dosage of ticarcillin need only be adjusted in severe renal function impairment. The drugs may be removed from patients undergoing dialysis; the actual amount removed depends on the duration and type of dialysis.
Indications and Usage
Treatment of bacterial septicemia, skin and skin structure infections, lower respiratory tract infections, bone and joint infections, GU and gynecologic infections, and intra-abdominal infections caused by susceptible strains of bacteria.
Hypersensitivity to penicillin.
Dosage and AdministrationSystemic and Urinary Tract Infections
Adults and Children Weighing 60 kg and Over
IV 3.1 g every 4 to 6 h.Adults and Children Weighing Less Than 60 kg
IV 200 to 300 mg/kg/day (based on ticarcillin component) in divided doses every 4 to 6 h.Gynecologic Infections
IV 200 to 300 mg/kg/day (based on ticarcillin component) in divided doses every 4 to 6 h.
- If using regular vial with powder for injection, reconstitute with 13 mL sterile water for injection or sodium chloride injection. Shake well to dissolve powder. Resulting solution contains approximately 200 mg ticarcillin/mL and 6.7 mg clavulanate/mL (each 5 mL of reconstituted solution contains 1 g ticarcillin and 33 mg clavulanate). Further dilute reconstituted solution to final concentration of 10 to 100 mg ticarcillin/mL with sodium chloride injection, dextrose 5% injection, or lactated Ringer's injection.
- Inspect solution visually before administration. Do not administer if solution is cloudy, discolored, or contains particulate matter. The normal color of reconstituted solution is light to dark yellow.
- Administer prescribed dose over 30 min by direct infusion or through a Y-type IV infusion set already in place. If using Y-type IV infusion set, temporarily discontinue administration of any other solution during infusion of ticarcillin and clavulanate potassium.
Store powder for injection at or below 75°F. Reconstituted solution is stable for up to 6 h if stored at room temperature (70° to 75°F) or up to 72 h if refrigerated (40°F). IV solution diluted (10 to 100 mg/mL) with lactated Ringer's injection or sodium chloride injection may be stored for up to 24 h at room temperature, up to 4 days if refrigerated, or 30 days if frozen (0°F). IV solution diluted (10 to 100 mg/mL) with dextrose 5% injection may be stored for up to 24 h at room temperature, up to 3 days if refrigerated, or 7 days if frozen. Frozen diluted IV solutions must be used within 8 h of thawing. Do not refreeze thawed solutions. Store premixed, frozen solutions at or below 4°F. Thaw at room temperature (72°F) or in refrigerator (39°F). Do not force thaw by immersion in water baths or by microwave irradiation. Thawed solution is stable for 24 h at room temperature or 7 days if refrigerated. Do not refreeze thawed solutions.
May increase bleeding risks of anticoagulant by prolonging bleeding time.Chloramphenicol
Synergism or antagonism may develop.Contraceptives, oral
May reduce efficacy of oral contraceptives. Use additional form of contraception during ticarcillin/clavulanate therapy.Erythromycin
Synergism or antagonism may develop.Heparin
May increase bleeding risks of heparin by prolonging bleeding time.Methotrexate
Serum methotrexate concentrations may be elevated, increasing the risk of toxicity.Probenecid
May increase ticarcillin levels.Tetracyclines
May impair bactericidal effects of ticarcillin/clavulanate.
May inactivate parenteral aminoglycosides in vitro; do not mix in same IV solution. May be used in combination for synergy. Ticarcillin/clavulanate is incompatible with sodium bicarbonate; not recommended as diluent.
Laboratory Test Interactions
May cause false-positive urine glucose test results with Benedict Solution, Fehling Solution, or Clinitest tablets but not with enzyme-based tests (eg, Clinistix , Tes-tape ); false-positive direct Coombs test in certain patient groups; positive direct antiglobulin tests (DAT); false-positive protein reactions with sulfosalicylic acid and boiling test, acetic acid test, biuret reaction, and nitric acid test but not with bromphenol blue test ( Multi-Stix ).
Convulsive seizures; giddiness; headache; neuromuscular hyperirritability.
Diarrhea; disturbed taste; epigastric pain; flatulence; nausea; pseudomembranous colitis; stomatitis; vomiting.
Eosinophilia; leukopenia; neutropenia; prolonged bleeding or PT; reduced hematocrit or hemoglobin; thrombocytopenia.
Cholestatic jaundice and transient hepatitis.
Hypersensitivity reactions including anaphylactic reactions, chest discomfort, chills, drug fever, erythema multiforme, myalgia, pruritus, skin rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, and urticaria.
Elevated ALT and AST, serum alkaline phosphatase, serum bilirubin, serum creatinine and or BUN, serum LDH; decreased serum potassium and uric acid; hypernatremia.
Burning; induration at injection site; pain; swelling; thrombophlebitis.
Category B .
Reactions range from mild to life-threatening. Administer cautiously to cephalosporin-sensitive patients because of possible cross-reactivity.
Dosage and interval adjustments necessary in renal insufficiency.
May result in bacterial or fungal overgrowth of nonsusceptible organisms.
Hemorrhagic manifestations associated with abnormalities of coagulation tests (bleeding time, prothrombin time, platelet aggregation) may occur. Abnormalities should revert to normal once drug is discontinued.
Ticarcillin has rarely decreased potassium levels.
May occur because of overgrowth of clostridia. Consider possibility in patients with diarrhea.
Powder for injection contains 4.75 mEq Na/g of ticarcillin.
Neuromuscular hyperexcitability, seizures.
- Advise patient or caregiver that medication will be prepared by a health care provider and administered in a health care setting.
- Review dosing schedule and prescribed length of therapy with patient. Advise patient that dose, dosing frequency, and duration of therapy are dependent on site of infection, severity of infection, and response to treatment.
- Advise patient or caregiver to immediately inform health care provider if injection site pain or redness, skin rash, hives, itching, or shortness of breath occur during treatment.
- Advise patient or caregiver to report signs of superinfection to health care provider: black “furry” tongue, white patches in mouth, foul-smelling stools, vaginal itching or discharge.
- Warn patient or caregiver that diarrhea containing blood or pus may be a sign of a serious disorder and, if noted after discharge, to seek medical care if noted and not treat at home.
Copyright © 2009 Wolters Kluwer Health.