Ticarcillin + Clavulanic Acid


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Susceptible infections >60 kg: 3.1 g (3 g of ticarcillin and 100 mg of clavulanic acid) 4-6 hrly for at least 48 hr after manifestations of infection have subsided. Duration: 5-7 days (intra-abdominal infections), 10-14 days (peritonitis). < 60 kg: As fixed dose combination, 200-300 mg ticarcillin/kg/day. Endometritis; Gynaecological infections As fixed dose combinations: 200 mg ticarcillin/kg/day. Severe: 300 mg ticarcillin/kg/day.
Dosage Details
Intravenous
Endometritis, Gynaecological infections
Adult: As fixed dose combinations: Moderate infection: 200 mg ticarcillin/kg daily; severe infections: 300 mg ticarcillin/kg daily.

Intravenous
Intra-abdominal infections, Lower respiratory tract infections, Peritonitis, Septicaemia, Skin infections, Urinary tract infections
Adult: >60kg: 3.1g (3 g of ticarcillin and 100 mg of clavulanic acid) as IV infusion over 30 min every 4-6 hr continued for at least 48 hr after manifestations of infection have subsided. Therapy may be 5-7 days for intra-abdominal infections; 10-14 days for peritonitis. < 60 kg: As fixed dose combination, 200-300 mg ticarcillin/kg daily.
Child: 3 mth-16 yr< 60 kg: 200 mg/kg of ticarcillin daily every 6 hr for mild to moderate infections; 300 mg/kg ticarcillin daily every 4 hr for severe infections. 3 mth-16 yr > 60 kg: 3.1 g (3 g of ticarcillin and 100 mg of clavulanic acid) every 6 hr for mild to moderate to every 4 hr for severe infections.
Renal Impairment
Intravenous:
Endometritis,Gynaecological infections: Haemodialysis: Initial loading dose of 3.1 g of fixed-ratio combination followed by a maintenance dosage of 2 g (in terms of ticarcillin) every 12 hr. An additional 3.1-g dose of the fixed-ratio combination to be admin after each dialysis period. Peritoneal dialysis: Initial loading dose of 3.1 g of fixed-ratio combination followed by 3.1 g of the fixed-ratio combination every 12 hr.
CrClDosage
<10Initial loading dose of 3.1 g, followed by 2 g every 12 hr.
<10 with hepatic impairmentInitial loading dose of 3.1 g, followed by 2 g once daily.
10-30Initial loading dose of 3.1 g, followed by 2 g every 8 hr
30-60Initial loading dose of 3.1 g, followed by 2 g every 4hr
Intra-abdominal infections,Lower respiratory tract infections,Peritonitis,Septicaemia,Skin infections,Urinary tract infections: Haemodialysis: Initial loading dose of 3.1 g of fixed-ratio combination followed by a maintenance dosage of 2 g (in terms of ticarcillin) every 12 hr. An additional 3.1-g dose of the fixed-ratio combination to be admin after each dialysis period. Peritoneal dialysis: initial loading dose of 3.1 g of fixed-ratio combination followed by 3.1 g of the fixed-ratio combination every 12 hr.
CrClDosage
<10Initial loading dose of 3.1 g, followed by 2 g every 12 hr.
<10 with hepatic impairmentInitial loading dose of 3.1 g, followed by 2 g once daily.
10-30Initial loading dose of 3.1 g, followed by 2 g every 8 hr.
30-60Initial loading dose of 3.1 g, followed by 2 g every 4hr.
Reconstitution
Intravenous:
Endometritis,Gynaecological infections: Add 13 ml of sterile water for injection or sodium chloride inj to a vial labeled as containing a combined potency of 3.1 g. This will provide a solution containing approx ticarcillin 200 mg/ml and clavulanic acid 6.7 mg/ml. This may be further diluted to 10-100 mg/ml in a compatible IV solution for intermittent infusion.
Intra-abdominal infections,Lower respiratory tract infections,Peritonitis,Septicaemia,Skin infections,Urinary tract infections: Add 13 mL of sterile water for injection or sodium chloride injection to a vial labeled as containing a combined potency of 3.1 g. This will provide a solution containing approximately ticarcillin 200mg/ml and clavulanic acid 6.7mg/ml. This may be further diluted to 10-100 mg/ml in a compatible IV solution for intermittent infusion.
Incompatibility
Ticarcillin is incompatible with sodium bicarbonate and aminoglycosides.
Contraindications
Hypersensitivity to penicillins.
Special Precautions
Restricted sodium diet. Restricted sodium diet. Very high doses in poor renal function (risk of neurotoxicity) or heart failure. Avoid contact; skin sensitisation may occur. Monitor electrolyte concentrations, renal, hepatic and hematologic function periodically during prolonged therapy. Discontinue therapy if bleeding manifestations occur. Lactation.
Adverse Reactions
Hypersensitivity reactions, GI disturbances, pseudomembranous colitis, blood dyscrasias, transient increase in liver enzymes, hepatitis, cholestatic jaundice, giddiness, neuromuscular hyperirritability, seizures, electrolyte disturbances, decreased serum uric acid concentration, increased serum creatinine and/or BUN concentrations. Thrombophlebitis and local reactions at the IV infusion site. Haemorrhagic cystitis especially in cystic fibrosis patients.
Potentially Fatal: Anaphylaxis.
Overdosage
Overdosage may cause neurotoxic effects, especially in patients with renal impairment. Treament is supportive and symptomatic. Haemodialysis can be used to enhance elimination of both ticarcillin and clavulanic acid.
Drug Interactions
Probenecid decreases clearance of ticarcillin. Increased bleeding risk with warfarin, acenocoumarol. Possible increase in ciclosporin, methotrexate levels with concurrent use. Possible contraceptive failure with combined oral contraceptives.
Lab Interference
May interfere with diagnostic tests for urinary glucose using copper sulfate, direct Coombs' test and test for serum proteins. May interfere with diagnostic tests that use bacteria. High urine concentrations may cause false-positive protein reactions with the following methods: Sulfosalicylic acid and boiling test, acetic acid test, biuret reaction and nitric acid test.
Action
Description: Ticarcillin and clavulanic acid is a fixed dose combination of ticarcillin disodium (a semisynthetic extended-spectrum penicillin) and the potassium salt of clavulanic acid (a β-lactamase inhibitor). Clavulanic acid, on its own has only weak antibacterial activity, but has a high affinity for β-lactamases that generally inactivate ticarcillin by hydrolysing its β-lactam ring. Hence clavulanic acid synergistically expands ticarcillin's spectrum of activity against many strains of β-lactamase-producing bacteria.
Pharmacokinetics:
Absorption: Absorption from GI: Ticarcillin: Poorly absorbed; clavulanate potassium: Well absorbed.
Distribution: Protein-binding: Ticarcillin 45-65%; clavulanic acid 22-30%. Both distributed into bone, blister and peritoneal fluid. Both cross placenta and distributed into breastmilk. Ticarcillin: Low distribution into CSF, higher when meninges are inflamed.
Metabolism: Clavulanate potassium: Extensively metabolised; ticarcillin: Limited metabolism.
Excretion: Excreted unchanged in urine: Ticarcillin 60-70%; clavulanic acid 35-45%.
Storage
Store below 24°C.
MIMS Class
Disclaimer: This information is independently developed by MIMS based on Ticarcillin + Clavulanic Acid from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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