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ticarcillin/clavulanate (Rx)Brand and Other Names:Timentin

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

ticarcillin/clavulanate

injection, powder for reconstitution

  • (3g/100mg)/vial
  • (30g/1g)/bulk vial

ready-to-use IV solution

  • (3g/100mg)/100mL
more...

Septicemia

Indicated for septicemia caused by beta-lactamase–producing isolates of Klebsiella spp, Escherichia coli, Staphylococcus aureus, or Pseudomonas aeruginosa

3.1 g IV q4-6hr

Lower Respiratory Infections

Indicated for lower respiratory infections caused by beta-lactamase–producing isolates of S. aureus, Haemophilus influenzae, or Klebsiella spp

3.1 g IV q4-6hr

Bone & Joint Infections

Indicated for bone and joint infections caused by beta-lactamase–producing isolates of S. aureus

3.1 g IV q4-6hr

Skin & Skin Structure Infections

Indicated for skin and skin structure infections caused by beta-lactamase–producing isolates of S. aureus, Klebsiella spp, or E. coli

3.1 g IV q4-6hr

Urinary Tract Infections

Indicated for UTIs (complicated or uncomplicated) caused by beta-lactamase–producing isolates of E. coli, Klebsiella spp, P. aeruginosa (or other Pseudomonas spp), Citrobacter spp, Enterobacter cloacae, Serratia marcescens, or S. aureus

3.1 g IV q4-6hr

Intra-abdominal Infections

Indicated for peritonitis caused by beta-lactamase–producing isolates of E. coli, K. pneumoniae, or Bacteroides fragilis group

3.1 g IV q4-6hr

Gynecologic Infections

Indicated for endometritis caused by beta-lactamase–producing isolates of Prevotella melaninogenicus, Enterobacter spp (including E. cloacae), E. coli, Klebsiella pneumoniae, S. aureus, or Staphylococcus epidermidis

Dose based on ticarcillin component

Moderate: 200 mg/kg/day IV divided q4-6hr 

Severe: 300 mg/kg/day IV divided q4hr

Renal Impairment

Load: 3.1 g IV, THEN reduce maintenance dose based on creatinine clearance

CrCl 30-60 mL/min: 2 g q4hr

CrCl 10-30 mL/min: 2 g q8hr

CrCl <10 mL/min: 2 g q12hr

CrCl<10 mL/min & hepatic impairment: 2 g qDay

Peritoneal dialysis: 3 g q12hr

Hemodialysis: 2 g q12hr; supplement with 3 g after each dialysis session

Dosing Considerations

Treatment duration depends upon infection severity, but is typically 10-14 days; however, in difficult and complicated infections, more prolonged therapy may be required

Dosage Forms & Strengths

ticarcillin/clavulanate

injection, powder for reconstitution

  • (3g/100mg)/vial
  • (30g/1g)/bulk vial

ready-to-use IV solution

  • (3g/100mg)/100mL
more...

Infections

Dose based on ticarcillin component

<3 months: Safety and efficacy not established

<60 kg and >3 months: 200-300 mg/kg/day IV divided q4-6hr; not to exceed 24 g/day

≥60 kg: As adults; 3.1 g IV q4-6hr

Neonates

  • (<7 days old, <2 kg) OR (>7 days old, <1.2 kg): 150 mg/kg/day IV divided q12hr
  • (<7 days old, >2 kg) OR (>7 days old, 1.2-2 kg): 225 mg/kg/day IV divided q8hr
  • >7 days old, >2 kg: 300 mg/kg/day IV divided q8hr

Cystic Fibrosis

300-600 mg/kg/day IV/IM divided q6hr; not to exceed 24 g/day 

Indications

Septicemia caused by beta-lactamase–producing isolates of Klebsiella spp, Escherichia coli, Staphylococcus aureus, or Pseudomonas aeruginosa

Lower respiratory infections caused by beta-lactamase–producing isolates of S. aureus, or Klebsiella spp; note that use is not established for Haemophilus influenzae type B

Bone and joint infections caused by beta-lactamase–producing isolates of S. aureus

Skin and skin structure infections caused by beta-lactamase–producing isolates of S. aureus, Klebsiella spp, or E. coli

UTIs (complicated or uncomplicated) caused by beta-lactamase–producing isolates of E. coli, Klebsiella spp, P. aeruginosa (or other Pseudomonas spp), Citrobacter spp, Enterobacter cloacae, Serratia marcescens, or S. aureus

Peritonitis caused by beta-lactamase–producing isolates of E. coli, K. pneumoniae, or Bacteroides fragilis group

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Interactions

Interaction Checker

ticarcillin/clavulanate and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Rash

            Nausea

            Diarrhea

            Phlebitis at injection site

            Increased eosinophils

            Increased AST

            Increased ALT

            Postmarketing Reports

            Hypersensitivity reactions: Skin rash, pruritus, urticaria, arthralgia, myalgia, drug fever, chills, chest discomfort, anaphylactic reactions, and bullous reactions (including erythema multiforme, toxic epidermal necrolysis, and Stevens-Johnson syndrome)

            CNS: Headache, giddiness, neuromuscular hyperirritability, or convulsive seizures

            Gastrointestinal: Disturbances of taste and smell, stomatitis, flatulence, nausea, vomiting and diarrhea, epigastric pain, and pseudomembranous colitis have been reported; onset of pseudomembranous colitis symptoms may occur during or after antibacterial treatment

            Hemic and lymphatic systems: Thrombocytopenia, leukopenia, neutropenia, eosinophilia, reduction of hemoglobin or hematocrit, and prolongation of prothrombin time and bleeding time

            Hepatic function tests: Elevation of AST, ALT, serum alkaline phosphatase, serum LDH, and serum bilirubin; transient hepatitis and cholestatic jaundice reported

            Renal: Hemorrhagic cystitis, elevation of serum creatinine and/or BUN, hypernatremia, reduction in serum potassium, and uric acid

            Local reactions: Pain, burning, swelling, and induration at the injection site, and thrombophlebitis with IV administration

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            Warnings

            Contraindications

            Allergy to penicillins or other beta-lactam antibacterials (eg, cephalosporins, imipenem)

            Cautions

            Serious and occasionally fatal hypersensitivity reactions reported

            Clostridium difficile associated diarrhea reported with use of nearly all antibacterial agents, including ticarcillin

            Seizures reported when dose exceeded, especially in presence of renal impairment

            Risk of bleeding complication

            Potential for microbial overgrowth or bacterial resistance

            Laboratory tests: High urine concentrations of ticarcillin may produce false-positive protein reactions; clavulanate may cause a nonspecific binding of IgG and albumin by RBC leading to a false-positive Coombs test

            Hypokalemia reported

            Monitor renal, hepatic, and hematologic function

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: excreted into breast milk at low concentrations; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Inhibits cell wall biosynthesis by binding to 1 of more penicillin binding proteins, which subsequently inhibits bacterial cell wall synthesis and has a bactericidal effect

            Absorption

            Absorption: 86% (IM)

            Peak Plasma Time: 30-75 min (IM)

            Peak Plasma Concentration: 324 mcg/mL (immediately after 30 min IV infusion of 3.1 g)

            AUC: 485 mcg•hr/mL (ticarcillin); 8.2 mcg•hr/mL (clavulanic acid)

            Distribution

            Protein Bound: 45 (ticarcillin); 25% (Clavulanate)

            Distributed into bile, low concentrations in CSF

            Metabolism

            Liver

            Elimination

            Half-life: 1.1 hr adults; 4.4 hr neonates; 1 hr infants/children

            Excretion: 60-70% urine (ticarcillin), 35-45% (clavulainic acid), excreted unchanged in first 6 hr after administration

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            Administration

            IV Incompatibilities

            Additive: sodium bicarbonate, aminoglycosides, ciprofloxacin(?)

            Y-site: alatrofloxacin, amphotericin B cholesteryl sulfate, azithromycin, cisatracurium(?), topotecan(?), vancomycin(?)

            IV Compatibilities

            Solution: compatible w/ most common solvents

            Y-site: (partial list) allopurinol, clarithromycin, diltiazem, fluconazole, heparin, meperidine, morphine, ondansetron, propofol

            IV Preparation

            Reconstitute 3.1 g vial with 13 mL SWI or NS; final concentration 200 mg/6.7 mg/mL

            For intermittent IV infusion, further dilute to 10-100 mg/mL (ticarcillin component with compatible IV solution

            Bulk vial 30 g/1 g

            • Not for direct infusion
            • Reconstitute with 76 mL SWI or NS; final concentration 300 mg/10 mg/mL
            • Further dilute before administration to 10-100 mg/mL (ticarcillin component)

            IV Administration

            Intermittent IV infusion over 30 min

            Administer 1 hr apart from aminoglycosides

            Storage

            Reconstituted solution is stable for 6 hr at room temperature and 72 hr when refrigerated

            IV infusion in NS is stable for 24 hr at room temperature and 7 days when refrigerated, or 30 days when frozen

            Darkening indicates loss of potency

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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