Ticarcillin/Clavulanate
Mechanism :
Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs), which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis.
Indication :
- Infections caused by beta-lactamase-producing isolates of S. aureus, Haemophilus influenzae, Klebsiella species, E. coli, Pseudomonas aeruginosa (or other Pseudomonas species), Citrobacter species, Enterobacter cloacae, Serratia marcescens.
Contraindications :
Hypersensitivity (history of a serious reaction [e.g., anaphylaxis, Stevens-Johnson syndrome]) to ticarcillin, clavulanate, or to other beta-lactams (e.g., penicillins, cephalosporins).
Dosing :
Infants ≥3 months, Children, and Adolescents: IV
<60 kg: 200 mg
ticarcillin/kg/day in divided doses every 6 hours. Maximum: 12 g daily.
≥60 kg: 3 g every 6 hours.
In severe infections, give every 4 hours. Maximum:
18 g daily.
Cystic fibrosis (off-label use): IV
400 mg
ticarcillin/kg/day in divided doses every 6 hours.
Adverse Effect :
Rash, nausea, diarrhea, phlebitis at injection site, increased eosinophils, increased AST, increased ALT.
Interaction :
Aminoglycosides: Penicillins may decrease the serum concentration of Aminoglycosides.
Tetracyclines: May diminish the therapeutic effect of Penicillins.
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| >30 | 3.2 g every 8 hours |
| 10-30 | 1.6 g every 8 hours |
| <10 | 1.6 g every 12 hours |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in GFR<10 mL/min |
| HD | Dialysed. Dose as in GFR<10 mL/min |
| HDF/High flux | Dialysed. Dose as in GFR<10 mL/min |
| CAV/VVHD | Unknown dialysability. Dose as in GFR=10–30 mL/min or 2.4 g every 6–8 hours1 |
| CVVHD/HDF | Dialysed. 3.2 g every 6 hours |
Hepatic Dose :
There are no pediatric specific recommendations; based on experience in adult patients, dosing adjustment suggested with concomitant renal dysfunction.