No

Antibiotic, Penicillin

Treatment of susceptible infections such as septicemia, acute and chronic respiratory tract infections, skin and soft tissue infections, and urinary tract infections due to susceptible strains of Pseudomonas, and other gram-negative bacteria

B

Hypersensitivity to ticarcillin or any component or penicillins

Due to sodium load and adverse effects (anemia, neuropsychological changes), use with caution and modify dosage in patients with renal impairment; serious and occasionally severe or fatal hypersensitivity (anaphylactoid) reactions have been reported in patients on penicillin therapy (especially with a history of beta-lactam hypersensitivity and/or a history of sensitivity to multiple allergens); use with caution in patients with seizures

Percentage unknown: Convulsions, confusion, drowsiness, fever, rash, electrolyte imbalance, hemolytic anemia, positive Coombs' reaction, eosinophilia, bleeding, thrombophlebitis, myoclonus, acute interstitial nephritis, hypersensitivity reactions, anaphylaxis, Jarisch-Herxheimer reaction

Symptoms of penicillin overdose include neuromuscular hypersensitivity (agitation, hallucinations, asterixis, encephalopathy, confusion, and seizures) and electrolyte imbalance with potassium or sodium salts, especially in renal failure

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:

Tetracyclines may decrease penicillin effectiveness

Aminoglycosides physical inactivation of aminoglycosides in the presence of high concentrations of ticarcillin

Decreased effectiveness of oral contraceptives

Increased effect:

Probenecid may increase penicillin levels

Neuromuscular blockers may increase duration of blockade

Potential toxicity in patients with with mild to moderate renal dysfunction

Aminoglycosides synergistic efficacy

Increased bleeding risk with large I.V. doses and anticoagulants

Reconstituted solution is stable for 72 hours at room temperature and 14 days when refrigerated; for I.V. infusion in NS or D₅W solution is stable for 72 hours at room temperature, 14 days when refrigerated or 30 days when frozen; after freezing, thawed solution is stable for 72 hours at room temperature or 14 days when refrigerated; incompatible with aminoglycosides

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: I.M.: 86%

Distribution: In blister fluid, lymph tissue, and gallbladder; crosses placenta; distributed into milk at low concentrations

Protein binding: 45% to 65%

Half-life:

Neonates: <1 week: 3.5-5.6 hours; 1-8 weeks: 1.3-2.2 hours

Children 5-13 years: 0.9 hour

Adults: 66-72 minutes, prolonged with renal impairment and/or hepatic impairment

Peak serum levels: I.M.: Within 30-75 minutes

Elimination: Almost entirely in urine as unchanged drug and its metabolites with small amounts excreted in feces (3.5%)

Ticarcillin is generally given I.V., I.M. injection is only for the treatment of uncomplicated urinary tract infections and dose should not exceed 2 g/injection when administered I.M.

Postnatal age <7 days:

<2000 g: 75 mg/kg/dose every 12 hours

>2000 g: 75 mg/kg/dose every 8 hours

Postnatal age >7 days:

<1200 g: 75 mg/kg/dose every 12 hours

1200-2000 g: 75 mg/kg/dose every 8 hours

>2000 g: 75 mg/kg/dose every 6 hours

Infants and Children:

Systemic infections: I.V.: 200-300 mg/kg/day in divided doses every 4-6 hours

Urinary tract infections: I.M., I.V.: 50-100 mg/kg/day in divided doses every 6-8 hours

Maximum dose: 24 g/day

Adults: I.M., I.V.: 1-4 g every 4-6 hours, usual dose: 3 g I.V. every 4-6 hours

Dosing adjustment in renal impairment: Adults:

Cl_cr 30-60 mL/minute: 2 g every 4 hours or 3 g every 8 hours

Cl_cr 10-30 mL/minute: 2 g every 8 hours or 3 g every 12 hours

Cl_cr <10 mL/minute: 2 g every 12 hours

Moderately dialyzable (20% to 50%)

Continuous arteriovenous or venovenous hemodiafiltration (CAVH) effects: Dose as for Cl_cr 10-50 mL/minute

Serum electrolytes, bleeding time, and periodic tests of renal, hepatic, and hematologic function; monitor for signs of anaphylaxis during first dose

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

May cause drowsiness or confusion; penicillins reported to cause apprehension, illusions, hallucinations, depersonalization, agitation, insomnia, and encephalopathy

None reported

No information available to require special precautions

Prolonged use of penicillins may lead to development of oral candidiasis

This medication will be administered I.V. or I.M. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). Small frequent meals, frequent mouth care, sucking lozenges, or chewing gum may reduce nausea or dry mouth. Maintain good oral and vaginal hygiene to reduce incidence of opportunistic infection. If diabetic, drug may cause false tests with Clinitest® urine glucose monitoring; use of glucose oxidase methods (Clinistix®) or serum glucose monitoring is preferable. This drug may interfere with oral contraceptives; an alternate form of birth control should be used. Report persistent diarrhea or abdominal pain (do not use antidiarrhea medication without consulting prescriber), fever, chills, unhealed sores, bloody urine or stool, muscle pain, mouth sores, difficulty breathing, or skin rash.

Draw sample for culture and sensitivity before administering first dose, if possible

Powder for injection, as disodium: 1 g, 3 g, 6 g, 20 g, 30 g

Brogden RN, Heel RC, Speight TM, et al, "Ticarcillin: A Review of Its Pharmacological Properties and Therapeutic Efficacy," Drugs, 1980, 20(5):325-52.

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

Nelson JD, Kusmiesz H, Shelton S, et al, "Clinical Pharmacology and Efficacy of Ticarcillin in Infants and Children," Pediatrics, 1978, 61(6):858-63.

Tan JS and File TM Jr, "Antipseudomonal Penicillins," Med Clin North Am, 1995, 79(4):679-93.

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

Yoshikawa TT, "Antimicrobial Therapy for the Elderly Patient," J Am Geriatr Soc, 1990, 38(12):1353-72.