Ticarcillin

Antibiotic Class:

Penicillin (carboxypenicillin)

Antimicrobial Spectrum:

Gram-positive:  Streptococcus spp., Listeria monocytogenes

Gram-negative:  Pseudomonas aeruginosa, Enterobacter, Providencia, Morganella, Proteus, H. influenzae, E. coli, Proteus mirabilis, Salmonella spp., Shigella spp.

Mechanism of Action:

Exerts bactericidal activity via inhibition of bacterial cell wall synthesis by binding one or more of the penicillin binding proteins (PBPs).  Exerts bacterial autolytic effect by inhibition of certain PBPs related to the activation of a bacterial autolytic process. 

Pharmacodynamics:

Penicillins produce time-dependent killing

Pharmacokinetics:

Cmax: 210mcg/ml; Half-life: 1.2mcg/ml; Table 6

Adverse Effects:

Hematologic:  eosinophilia, hemolytic anemia, thrombocytopenia, neutropenia

Endocrine: hypokalemia

Renal:  nephrotoxicity, interstitial nephritis

Hepatic:  transient increases in transaminases

Other:  Jarisch-Herxheimer Reaction (fever, chills, sweating, tachycardia, hyperventilation, flushing, and myalgia)

Dosage:

Adult: 3g IV q4h 

Pediatric: > 1 month and < 40 kg: 100-300 mg/kg/day in 4-6 divided doses

40 kg: usual adult dose

Disease state based dosing:

Renal failure:  CrCL 30-60 mL/min: 2g q4h

CrCL 10-30 mL/min: 2g q8h

CrCL < 10 mL/min: 2g q12h

 Supplement after Hemodialysis: 3g

Contraindications/Warnings/Precautions:

Contraindications:  Anaphylaxis to ticarcillin or other penicillins

Precautions: 

Drug Interactions:

Live Typhoid Vaccine - decreased immunological response to the typhoid vaccine

Probenecid - increased ticarcillin levels

Pregnancy:

Category B: No evidence of risk in humans but studies inadequate.

Monitoring Requirements:

Therapeutic:  Culture and sensitivities, signs and symptoms of infection

Toxic:  Periodic CBC, urinalysis, BUN, SCr, AST and ALT, diarrhea, skin rash

Brand names/Manufacturer:

         AERUGIPEN (Beecham - GERMANY)

         TARCIL (SmithKline Beecham - AUSTRALIA)

         TICAR (GlaxoSmithKline USA, CANADA, UK)

         TICARPEN (GlaxoSmithKline FRANCE, NETHERLANDS)

         TICILLIN (CSL - AUSTRALIA)

         TRIACILLINE (Smith Kline Beecham - BELGIUM)