Ticarcillin/Clavulanate

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

Pharmacology

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

Antibiotic Sensitivities

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

• Antibiotics (Main)

References

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