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Paul A. Pham, Pharm.D. and John G. Bartlett,M.D.
10-13-2009
-
Available formulation in Zambia: IV: 3gm vial. Availability varies.
-
Pseudomonas pneumonia: Ticarcillin 3gm q4h plus gentamicin.
Zambia Information Author: Paul A. Pham, Pharm. D.
- Only available in the U.S. as ticarcillin plus clavulanic acid.
- Gynecologic infections (endomyometritis)
- Intra-abdominal infections
- Lower respiratory infections
- Septicemia
- Skin and skin structure infections
- Urinary tract infections
- Bone and joint infections
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
| Ticar (no longer available in U.S.; only available in U.S. as ticarcillin/clavulanate) | Ticarcillin | | IV
vial
3 gm | n/a |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
3 g IV q4-6h (up to 24 g/day). Use 3 g IV q4h for serious infections.
GFR >60ml/min: standard dose 3 g IV q4-6h (up to 24 g per day). Pulmonary, pseudomonal, and serious infections: 3 g IV q4h.
30-60ml/min: 2gm q4h . If <30ml/min: 2gm q8h.
2 g q12h.
2 g q12h plus 3 g post-dialysis.
3 g q12h.
CVVH: 2 g q6-8h. CVVHD: 3 g q8-6h.
- Hypersensitivity reactions
- Rash
- GI intolerance
- Phlebitis at infusion sites
- Jarisch-Herxheimer reaction (with syphilis or other spirochetal infections)
-
C. difficile colitis
- LFTs elevations with rare cases of hepatitis
- Drug fever
- Coombs' test positive w/ hemolytic anemia
- Interstitial nephritis
- Leukopenia and thrombocytopenia
- Abnormal platelet aggregation with bleeding diathesis (especially in renal failure)
- CNS: seizures and twitching (with high doses in patients with renal failure)
- Hepatitis
- Anaphylaxis
- Oral contraceptives: may decrease efficacy of oral contraceptives.
- Probenecid: may prolong ticarcillin half-life. May be result in significant accumulation in renal failure.
- Tetracyclines: in vitro antagonism when co-administered. Bactericidal effect of penicillins may be diminished in vivo. Management recommendation: avoid concurrent administration. In two studies involving a total of 79 patients with pneumococcal meningitis treated with either penicillin plus tetracyclines or penicillin monotherapy resulted in a higher mortality rate (79-85%) in the combination therapy compared to penicillin monotherapy (30-33%) [Arch Intern Med 1951:88:489, Ann Intern Med 1961; 55:545]. However there was nodifference in mortality between penicillin monotherapy and penicillin plus tetracycline in treatment of pneumococcal pneumonia [Arch Intern Med 1953; 91:197].
Anti-pseudomonal penicillin only available in the U.S in the form of ticarcillin/clavulanic acid. Contains 4.75 mEq of sodium per gm of ticarcillin. Reduced enterococcal activity compared to piperacillin. Reduced activity againstS. pneumoniae. Hydrolized by plasmid-mediated beta-lactamases.
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