ticarcillin disodium and clavulanate potassium

Action

Ticarcillin disodium inhibits bacterial cell-wall synthesis during replication; clavulanic acid extends ticarcillin's antibiotic spectrum by inactivating beta-lactamase enzymes (which otherwise would degrade ticarcillin).

Availability

Injection: 3 g ticarcillin and 100 mg clavulanic acid in 3.1-g vials

Indications and dosages

➣ Systemic and urinary tract infections caused by susceptible organisms

Adults weighing more than 60 kg (132 lb): 3.1 g (30:1 fixed-ratio combination of 3 g ticarcillin and 100 mg clavulanic acid) by I.V. infusion q 4 to 6 hours

Adults weighing less than 60 kg (132 lb): 200 to 300 mg/kg/day (based on ticarcillin content) by I.V. infusion in divided doses q 4 to 6 hours

➣ Gynecologic infections caused by susceptible organisms

Adults weighing more than 60 kg (132 lb): For moderate infections, 200 mg/kg/day (based on ticarcillin content) by I.V. infusion in divided doses q 6 hours. For severe infections, 300 mg/kg/day (based on ticarcillin content) by I.V. infusion in divided doses q 4 hours.

Adults weighing less than 60 kg (132 lb): 200 to 300 mg/kg/day by I.V. infusion q 4 to 6 hours

➣ Mild to moderate or severe infections in children caused by susceptible organisms

Children weighing more than 60 kg (132 lb): For mild to moderate infections, 3.1 g (30:1 fixed-ratio combination of 3 g ticarcillin and 100 mg clavulanic acid) by I.V. infusion q 6 hours. For severe infections, 3.1 g (30:1 fixed-ratio combination of 3 g ticarcillin and 100 mg clavulanic acid) by I.V. infusion q 4 hours.

Children ages 3 months to 16 years weighing less than 60 kg (132 lb): For mild to moderate infections, 200 mg/kg/day (based on ticarcillin content) by I.V. infusion in divided doses q 6 hours. For severe infections, 300 mg/kg/day (based on ticarcillin content) by I.V. infusion in divided doses q 4 hours.

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to drug or other penicillins

Precautions

Use cautiously in:

• cystic fibrosis, renal or hepatic disease

• pregnant or breastfeeding patients.

Administration

• Ask patient about penicillin allergy before giving.

• Add 13 ml of sterile water or normal saline solution to vial; shake gently. Dilute further to 10 to 100 mg/ml of ticarcillin; infuse I.V. over 30 minutes.

• Give at least 1 hour before I.V. aminoglycosides (such as amikacin or gentamicin).

Adverse reactions

CNS: headache, giddiness, dizziness, lethargy, fatigue, hyperreflexia, neuromuscular excitability, asterixis, hallucinations, stupor, seizures

GI: nausea, vomiting, diarrhea, flatulence, pseudomembranous colitis

Hematologic: eosinophilia, transient neutropenia and leukopenia (with high doses)

Skin: urticaria, rash

Other: unpleasant taste; fever; overgrowth of nonsusceptible organisms; pain, vein irritation, erythema, phlebitis, and thrombophlebitis at I.V. site; hypersensitivity reactions including anaphylaxis

Interactions

Drug-drug. Aminoglycosides: physical incompatibility, causing aminoglycoside inactivation when mixed in same I.V. solution

Aminoglycosides, tetracyclines: additive activity against some bacteria

Lithium: altered lithium elimination

Probenecid: increased ticarcillin blood level

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, eosinophils, lactate dehydrogenase, sodium: increased levels

Bleeding time: prolonged

Granulocytes, hemoglobin, platelets, white blood cells: decreased levels

Liver function tests: transient increases

Urine glucose, urine protein: false-positive results

Patient monitoring

• Monitor liver function tests and CBC with white cell differential.

• Watch closely for signs and symptoms of superinfection and severe allergic reactions.

• Assess neurologic status, and stay alert for seizures.

Patient teaching

Advise patient to report skin reactions and severe diarrhea right away.

Tell patient drug may increase risk of other infections. Advise him to promptly report signs and symptoms of new infection.

• Instruct patient to limit sodium intake (drug contains sodium).

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.