Ticarcillin/Clavulanate: Difference between revisions
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'''Brand Discontinued in U.S
'''
==General==
==General==
*Type: Anti-Pseudomonal [[Penicillin]]
*Type: [[Is PenicillinType::Anti-Pseudomonal]] [[Is DrugClass::Penicillin]]
*Dosage Forms:
*Dosage Forms:
*Common Trade Names: Timentin
*Common Trade Names: Timentin
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===General===
===General===
*<60 kg  
*<60 kg  
**200-300 mg ticarcillin/kg/day IV divided q4-6 hours  
**200-300mg ticarcillin/kg/day IV divided q4-6 hours  
**First Dose:   
**First Dose:   
**Max: 18 g/day
**Max: 18 g/day
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===General (≥3 Months)===
===General (≥3 Months)===
*'''<60 kg'''
*'''<60 kg'''
**200-300 mg ticarcillin/kg/day IV divided q4-6 hours  
**200-300mg ticarcillin/kg/day IV divided q4-6 hours  
**First Dose: 50 mg tiacarcillin/kg IV x 1
**First Dose: 50mg tiacarcillin/kg IV x 1
**Max: 18g/day
**Max: 18g/day
*'''≥60 kg'''
*'''≥60 kg'''
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==Special Populations==
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy]]: B
*[[Drug Ratings in Pregnancy|Pregnancy]]: B
*Lactation:
*Lactation: Use caution
*Renal Dosing
*Renal Dosing
Considerations for hemodialysis/peritoneal dialysis and CRRT patients NOT included below
**Adult
**Adult
Loading dose: IV: 3.1 g one dose, followed by maintenance dose based on creatinine clearance:
CrCl 30-60 mL/minute: 2 g of ticarcillin component every 4 hours
CrCl 10-30 mL/minute: 2 g of ticarcillin component every 8 hours
CrCl <10 mL/minute: 2 g of ticarcillin component every 12 hours
CrCl <10 mL/minute with concomitant hepatic dysfunction: 2 g of ticarcillin component every 24 hours
**Pediatric
**Pediatric
No dosing adjustments in manufacturer's label, clinical recommendations include:
GFR >30 mL/minute/1.73 m2: No adjustment required.
GFR 10-29 mL/minute/1.73 m2: 50 to 75 mg ticarcillin/kg every 8 hours
GFR <10 mL/minute/1.73 m2 (without concomitant hepatic failure): 50 to 75 mg ticarcillin/kg every 12 hours
GFR <10 mL/minute/1.73 m2 (with concomitant hepatic failure): 50 to 75 mg ticarcillin/kg every 24 hours
*Hepatic Dosing
*Hepatic Dosing
**Adult
**Adult
With concomitant renal dysfunction (Clcr <10 mL/minute): 2 g of ticarcillin component every 24 hours.
**Pediatric
**Pediatric
No specific pediatric recommendations, adjust if concomitant renal dysfunction


==Contraindications==
==Contraindications==
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==Pharmacology==
==Pharmacology==
*Half-life:  
*Half-life: Ticarcillin: 1.1 hours; Clavulanic acid: 1.1 hours
*Metabolism:  
*Metabolism:  
*Excretion:  
*Excretion:  
*Mechanism of Action:
*Mechanism of Action:
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''Sensitivity'''
|-
| Gram Positive||[[Strep. Group A, B, C, G]]||'''S'''
|-
| ||[[Strep. Pneumoniae]]||'''S'''
|-
| ||[[Viridans strep]]||I
|-
| ||Strep. anginosus gp||'''S'''
|-
| ||[[Enterococcus faecalis]]||I
|-
| ||[[Enterococcus faecium]]||I
|-
| ||[[MSSA]]||'''S'''
|-
| ||[[MRSA]]||R
|-
| ||[[CA-MRSA]]||R
|-
| ||[[Staph. Epidermidis]]||I
|-
| ||[[C. jeikeium]]||R
|-
| ||[[L. monocytogenes]]||X2
|-
| Gram Negatives||[[N. gonorrhoeae]]||X2
|-
| ||[[N. meningitidis]]||'''S'''
|-
| ||[[Moraxella catarrhalis]]||'''S'''
|-
| ||[[H. influenzae]]||'''S'''
|-
| ||[[E. coli]]||'''S'''
|-
| ||[[Klebsiella]] sp||'''S'''
|-
| ||E. coli/Klebsiella ESBL+||R
|-
| ||E coli/Klebsiella KPC+||R
|-
| ||[[Enterobacter]] sp, AmpC neg||'''S'''
|-
| ||[[Enterobacter]] sp, AmpC pos||'''S'''
|-
| ||[[Serratia]] sp||'''S'''
|-
| ||Serratia marcescens||X1
|-
| ||[[Salmonella]] sp||'''S'''
|-
| ||[[Shigella]] sp||'''S'''
|-
| ||[[Proteus mirabilis]]||'''S'''
|-
| ||[[Proteus vulgaris]]||'''S'''
|-
| ||[[Providencia sp.]]||'''S'''
|-
| ||[[Morganella sp.]]||'''S'''
|-
| ||[[Citrobacter freundii]]||'''S'''
|-
| ||[[Citrobacter diversus]]||'''S'''
|-
| ||[[Citrobacter sp.]]||'''S'''
|-
| ||[[Aeromonas sp]]||'''S'''
|-
| ||[[Acinetobacter sp.]]||I
|-
| ||[[Pseudomonas aeruginosa]]||'''[[Has Antipseudomonal::S]]'''
|-
| ||[[Burkholderia cepacia]]||X1
|-
| ||[[Stenotrophomonas maltophilia]]||'''S'''
|-
| ||[[Yersinia enterocolitica]]||'''S'''
|-
| ||[[Francisella tularensis]]||X1
|-
| ||[[Brucella sp.]]||X1
|-
| ||[[Legionella sp.]]||R
|-
| ||[[Pasteurella multocida]]||'''S'''
|-
| ||[[Haemophilus ducreyi]]||X1
|-
| ||[[Vibrio vulnificus]]||X1
|-
| Misc||[[Chlamydophila sp]]||R
|-
| ||[[Mycoplasm pneumoniae]]||R
|-
| ||[[Rickettsia sp]]||X1
|-
| ||[[Mycobacterium avium]]||X1
|-
| Anaerobes||[[Actinomyces]]||X1
|-
| ||[[Bacteroides fragilis]]||'''S'''
|-
| ||[[Prevotella melaninogenica]]||'''S'''
|-
| ||[[Clostridium difficile]]||X1
|-
| ||[[Clostridium (not difficile)]]||'''S'''
|-
| ||[[Fusobacterium necrophorum]]||'''S'''
|-
| ||[[Peptostreptococcus sp.]]||'''S'''
|}
===Key===
{{Template:Antibacterial Spectra Key}}


==See Also==
==See Also==
*[[Antibiotics (Main)]]
*[[Antibiotics (Main)]]


==Source==
==References==
 
<references/>
<references/>
[[Category:Drugs]]
[[Category:Pharmacology]]
Dowell JA, Korth-Bradley J, Milisci M, et al, "Evaluating Possible Pharmacokinetic Interactions Between Tobramycin, Piperacillin, and a Combination of Piperacillin and Tazobactam in Patients With Various Degrees of Renal Impairment," J Clin Pharmacol, 2001, 41:979-86 PMID: 11549103

Latest revision as of 17:51, 18 July 2025

Brand Discontinued in U.S

General

  • Type: Anti-Pseudomonal Penicillin
  • Dosage Forms:
  • Common Trade Names: Timentin

Adult Dosing

Ticarcillin/clavulanate: each 3.1g dose contains 3g ticarcillin and 0.1g clavulanate (dosages written by ticarcillin component)

General

  • <60 kg
    • 200-300mg ticarcillin/kg/day IV divided q4-6 hours
    • First Dose:
    • Max: 18 g/day
  • ≥60 kg
    • 3.1 g every 4-6 hours
    • First Dose:
    • Max: 18 g/day

Pediatric Dosing

Ticarcillin/clavulanate: each 3.1g dose contains 3g ticarcillin and 0.1g clavulanate (dosages written by ticarcillin component)

General (≥3 Months)

  • <60 kg
    • 200-300mg ticarcillin/kg/day IV divided q4-6 hours
    • First Dose: 50mg tiacarcillin/kg IV x 1
    • Max: 18g/day
  • ≥60 kg
    • 3.1 g q4-6 hours
    • Max: 18g/day

Special Populations

  • Pregnancy: B
  • Lactation: Use caution
  • Renal Dosing

Considerations for hemodialysis/peritoneal dialysis and CRRT patients NOT included below

    • Adult

Loading dose: IV: 3.1 g one dose, followed by maintenance dose based on creatinine clearance:

CrCl 30-60 mL/minute: 2 g of ticarcillin component every 4 hours

CrCl 10-30 mL/minute: 2 g of ticarcillin component every 8 hours

CrCl <10 mL/minute: 2 g of ticarcillin component every 12 hours

CrCl <10 mL/minute with concomitant hepatic dysfunction: 2 g of ticarcillin component every 24 hours

    • Pediatric

No dosing adjustments in manufacturer's label, clinical recommendations include:

GFR >30 mL/minute/1.73 m2: No adjustment required.

GFR 10-29 mL/minute/1.73 m2: 50 to 75 mg ticarcillin/kg every 8 hours

GFR <10 mL/minute/1.73 m2 (without concomitant hepatic failure): 50 to 75 mg ticarcillin/kg every 12 hours

GFR <10 mL/minute/1.73 m2 (with concomitant hepatic failure): 50 to 75 mg ticarcillin/kg every 24 hours

  • Hepatic Dosing
    • Adult

With concomitant renal dysfunction (Clcr <10 mL/minute): 2 g of ticarcillin component every 24 hours.

    • Pediatric

No specific pediatric recommendations, adjust if concomitant renal dysfunction

Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life: Ticarcillin: 1.1 hours; Clavulanic acid: 1.1 hours
  • Metabolism:
  • Excretion:
  • Mechanism of Action:

Antibiotic Sensitivities[1]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G S
Strep. Pneumoniae S
Viridans strep I
Strep. anginosus gp S
Enterococcus faecalis I
Enterococcus faecium I
MSSA S
MRSA R
CA-MRSA R
Staph. Epidermidis I
C. jeikeium R
L. monocytogenes X2
Gram Negatives N. gonorrhoeae X2
N. meningitidis S
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp S
E. coli/Klebsiella ESBL+ R
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg S
Enterobacter sp, AmpC pos S
Serratia sp S
Serratia marcescens X1
Salmonella sp S
Shigella sp S
Proteus mirabilis S
Proteus vulgaris S
Providencia sp. S
Morganella sp. S
Citrobacter freundii S
Citrobacter diversus S
Citrobacter sp. S
Aeromonas sp S
Acinetobacter sp. I
Pseudomonas aeruginosa S
Burkholderia cepacia X1
Stenotrophomonas maltophilia S
Yersinia enterocolitica S
Francisella tularensis X1
Brucella sp. X1
Legionella sp. R
Pasteurella multocida S
Haemophilus ducreyi X1
Vibrio vulnificus X1
Misc Chlamydophila sp R
Mycoplasm pneumoniae R
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces X1
Bacteroides fragilis S
Prevotella melaninogenica S
Clostridium difficile X1
Clostridium (not difficile) S
Fusobacterium necrophorum S
Peptostreptococcus sp. S

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. ↑ Sanford Guide to Antimicrobial Therapy 2014

Dowell JA, Korth-Bradley J, Milisci M, et al, "Evaluating Possible Pharmacokinetic Interactions Between Tobramycin, Piperacillin, and a Combination of Piperacillin and Tazobactam in Patients With Various Degrees of Renal Impairment," J Clin Pharmacol, 2001, 41:979-86 PMID: 11549103

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