Ticarcillin

Intravenous
Severe Gram-negative infections, Skin infections, Septicaemia, Peritonitis, Bone and joint infections

Parenteral
Complicated urinary tract infections

Parenteral
Uncomplicated urinary tract infections

Intravenous:
Peritoneal dialysis patients: 3 g every 12 hr; haemodialysis patients: 2 g every 12 hr plus an additional dose of 3 g after each dialysis session.

CrCl	Dosage
<10	Initial IV loading dose of 3 g, followed by 2 g every 12 hr (or 1 g IM every 6 hr).
<10> with hepatic impairment	Initial IV loading dose of 3 g, followed by 2 g IV every 24 hr or 1 g IM every 12 hr.
10-30	Initial IV loading dose of 3 g, followed by 2 g every 8 hr.
30-60	Initial IV loading dose of 3 g, followed by 2 g every 4 hr.

Parenteral:
Complicated urinary tract infections: Peritoneal dialysis patients: 3 g every 12 hr; haemodialysis patients: 2 g every 12 hr plus an additional dose of 3 g after each dialysis session.

CrCl	Dosage
<10	Initial IV loading dose of 3 g, followed by 2 g every 12 hr (or 1 g IM every 6 hr).
<10 with hepatic impairment	Initial IV loading dose of 3 g, followed by 2 g IV every 24 hr or 1 g IM every 12 hr.
10-30	Initial IV loading dose of 3 g, followed by 2 g every 8 hr.
30-60	Initial IV loading dose of 3 g, followed by 2 g every 4 hr.

Incompatible with aminoglycosides.

Hypersensitivity to penicillins.

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 haematological status during prolonged and high dose therapy. Jarisch-Herxheimer reaction may be seen in spirochete infections particularly syphilis; avoid intrathecal route.

Pain at the inj site and phlebitis; electrolyte disturbances (hypokalaemia or hypernatraemia); dose-dependent coagulation defect; purpura and haemorrhage; hypersensitivity reactions; haemolytic anaemia; interstitial nephritis; neutropenia; CNS toxicity including convulsions; diarrhoea; pseudomembranous colitis. Haemorrhagic cystitis especially in cystic fibrosis patients.
Potentially Fatal: Anaphylaxis.

IM/IV/Parenteral: B

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.

May interfere with diagnostic tests for urinary glucose using copper sulfate, direct Coombs' test, and test for urinary or serum proteins. May interfere with diagnostic tests that use bacteria.

Description: Ticarcillin is bactericidal through inhibition of the final cross-linking stage of peptidoglycan production by binding and inactivating transpeptidases thus inhibiting bacterial cell wall synthesis. It is active against gram-positive bacteria, gram-negative cocci, Pseudomonas aeruginosa, spirochetes, actinomycetes and has an extended spectrum of gram-negative bacteria compared to benzylpenicillin.
Pharmacokinetics:
Absorption: Not absorbed from GI tract. Peak plasma concentrations: 0.5-1 hr (IM).
Distribution: Widely distibuted. Protein-binding: 50%. Plasma half-life: 70 min; 50 min (patients with cystic fibrosis).
Metabolism: Limited metabolism.
Excretion: 90% excreted unchanged in urine.

Penicillins