No

Antibiotic, Penicillin

Treatment of serious urinary tract infections and prostatitis caused by susceptible gram-negative aerobic bacilli

B

Hypersensitivity to carbenicillin or any component or penicillins

Do not use in patients with severe renal impairment (Cl_cr <10 mL/minute); dosage modification required in patients with impaired renal and/or hepatic function; oral carbenicillin should be limited to treatment of urinary tract infections. Use with caution in patients with history of hypersensitivity to cephalosporins.

>10%: Gastrointestinal: Diarrhea

1% to 10%: Gastrointestinal: Nausea, bad taste, vomiting, flatulence, glossitis

<1%: Headache, skin rash, urticaria, anemia, thrombocytopenia, leukopenia, neutropenia, eosinophilia, hyperthermia, itchy eyes, vaginitis, hypokalemia, hematuria, thrombophlebitis

Symptoms of overdose include neuromuscular hypersensitivity, convulsions; many beta-lactam containing antibiotics have the potential to cause neuromuscular hyperirritability or convulsive seizures

Hemodialysis may be helpful to aid in the removal of the drug from the blood, otherwise most treatment is supportive or symptom directed

Decreased effect with administration of aminoglycosides within 1 hour; may inactivate both drugs

Increased duration of half-life with probenecid

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. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Absorption: Oral: 30% to 40%

Distribution: Crosses the placenta; small amounts appear in breast milk; distributes into bile, low concentrations attained in CSF

Half-life: Children: 0.8-1.8 hours; Adults: 1-1.5 hours, prolonged to 10-20 hours with renal insufficiency

Time to peak serum concentration: Within 0.5-2 hours in patients with normal renal function; serum concentrations following oral absorption are inadequate for treatment of systemic infections

Elimination: ~80% to 99% excreted unchanged in urine

Oral:

Adults: 1-2 tablets every 6 hours for urinary tract infections or 2 tablets every 6 hours for prostatitis

Dosing interval in renal impairment: Adults:

Cl_cr 10-50 mL/minute: Administer 382-764 mg every 12-24 hours

Cl_cr <10 mL/minute: Administer 382-764 mg every 24-48 hours

Moderately dialyzable (20% to 50%)

Should be administered with water on empty stomach

Renal, hepatic, and hematologic function tests

Therapeutic: Not established; Toxic: >250 mg/mL (SI: >660 mmol/L)

May interfere with urinary glucose tests using cupric sulfate (Benedict's solution, Clinitest®); may inactivate aminoglycosides in vitro; false-positive urine or serum proteins

Penicillins have been reported to cause apprehension, illusions, agitation, insomnia, depersonalization, and encephalopathy

Rare reports of leukopenia and neutropenia; use caution with clozapine and carbamazepine

No information available to require special precautions

Prolonged use of penicillins may lead to development of oral candidiasis

Take as prescribed, at equal intervals around-the-clock, with a full glass of water, and preferably on an empty stomach (1 hour before or 2 hours after meals). Do not skip doses and take full course of treatment even if feeling better. Frequent mouth care will help relieve dry mouth and bitter aftertaste. Report swelling, respiratory difficulty, easy bruising or bleeding, or signs of opportunistic infection (eg, sore throat, fever, chills, fatigue, thrush, vaginal discharge, diarrhea). If diabetic, drug may cause false tests with Clinitest® urine glucose monitoring; use of glucose oxidase methods (Clinistix®) or serum glucose monitoring is preferable. Pregnancy/breast-feeding precautions: This drug may interfere with oral contraceptives; an alternate form of birth control should be used. Consult prescriber if breast-feeding.

Administer around-the-clock to promote less variation in peak and trough serum levels

Watch for increased edema, rales, or signs of congestion, bruising, or bleeding; monitor renal, hepatic, and hematologic function tests

Tablet, film coated: 382 mg

Donowitz GR and Mandell GL, "Beta-Lactam Antibiotics," N Engl J Med, 1988, 318(7):419-26 and 318(8):490-500.

Wright AJ, "The Penicillins," Mayo Clin Proc, 1999, 74(3):290-307.