Ticarcillin/Clavulanate (Ticarcillin Disodium and Clavulanate Potassium)

A to Z Drug Facts

 Action Ticarcillin inhibits bacterial cell wall mucopeptide synthesis. Clavulanate lactamase enzymes commonly found in microorganisms resistant to ticarcillin.

 Indications Treatment of bacterial septicemia, skin and skin structure infections, lower respiratory tract infections, bone and joint infections, genitourinary and gynecologic infections, and intra-abdominal infections caused by susceptible strains of bacteria.

 Contraindications Hypersensitivity to penicillin.

 Route/Dosage

Systemic and Urinary Tract Infections

ADULTS & CHILDREN ³ 60 KG: IV 3.1 g q 4–6 hr. ADULTS & CHILDREN < 60 KG: IV 200–300 mg/kg/day in divided doses q 4–6 hr.

Gynecologic Infections

ADULTS: IV 200–300 mg/kg/day in divided doses q 4–6 hr.

 Interactions

Anticoagulants: May increase bleeding risks of anticoagulant by prolonging bleeding time. Chloramphenicol: Synergism or antagonism may develop. Contraceptives, oral: May reduce efficacy of oral contraceptives. Use additional form of contraception during ticarcillin/clavulanate therapy. Erythromycin: Synergism or antagonism may develop. Heparin: May increase bleeding risks of heparin by prolonging bleeding time. Probenecid: May increase ticarcillin levels. Sodium bicarbonate: Ticarcillin/clavulanate is incompatible with sodium bicarbonate; not recommended as diluent. Tetracyclines: May impair bactericidal effects of ticarcillin/clavulanate. INCOMPATIBILITIES: Aminoglycosides, parenteral: May inactivate aminoglycosides in vitro; o not mix in same IV solution. May be used in combination for synergy.

 Lab Test Interferences May cause false-positive urine glucose test results with Benedict's Solution, Fehling's Solution, or Clinitest tablets but not with enzyme-based tests (e.g., Clinistix, Tes-tape); alse-positive direct Coombs' test in certain patient groups; positive direct antiglobulin tests (DAT); false-positive protein reactions with sulfosalicylic acid and boiling test, acetic acid test, biuret reaction and nitric acid test but not with bromphenol blue test (Multi-Stix).

 Adverse Reactions

CV: Deep vein thrombosis; vein irritation; phlebitis. CNS: Neurotoxicity (lethargy, neuromuscular irritability and seizures). DERM: Rash; pruritis; urticaria; ecchymosis. GI: Nausea; vomiting; abdominal pain or cramp; diarrhea; pseudomembranous colitis. GU: Elevated creatinine or BUN; vaginitis. HEMA: Anemia; hemolytic anemia; thrombocytopenia; eosinophilia; leukopenia; ranulocytopenia; neutropenia; prolongation of bleeding and prothrombin time. HEPA: Transient hepatitis; cholestatic jaundice. META: Elevated serum alkaline phosphatase; hypernatremia; reduced serum potassium. OTHER: Hypersensitivity reactions; pain at site of injection; hematomas; hyperthermia.

 Precautions

Pregnancy: Category B. Lactation: Excreted in breast milk. Bleeding abnormalities: Hemorrhagic manifestations associated with abnormalities of coagulation tests (bleeding time, prothrombin time, platelet aggregation) may occur. Abnormalities should revert to normal once drug is discontinued. Hypersensitivity: Reactions range from mild to life-threatening. Administer cautiously to cephalosporin-sensitive patients due to possible cross-reactivity. Hypokalemia: Ticarcillin has rarely decreased potassium levels. Pseudomembranous colitis: May occur due to overgrowth of clostridia. Renal insufficiency: Dosage and interval adjustments necessary. Sodium content: Powder for injection contains 4.75 mEq Na/gram of ticarcillin. Superinfection: May result in bacterial or fungal overgrowth of non-susceptible organisms.

 Administration/Storage

• To reconstitute: Add approximately 13.0 ml of Sterile Water for Injection or Sodium Chloride Injection. Then dilute further to concentrations of 10–100 mg/ml with NaCl, 5% Dextrose or Lactated Ringer's.
• Administer IV over 30 min by direct infusion or by piggyback.
• Discontinue other solutions while this drug is being infused via piggy-back.
• Do not mix sodium bicarbonate, gentamicin, amikacin or tobramycin in same IV solution.
• Store concentrated stock solution (200 mg/ml) no longer than 6 hr at room temperature or 72 hr under refrigeration.
• Store concentrations of 10–100 mg/ml in Sodium Chloride for Injection or Lactated Ringer's no longer than 24 hr at room temperature; 7 days under refrigeration or 30 days frozen. Store solutions made with 5% extrose no longer than 24 hr at room temperature, 3 days under refrigeration or 7 days frozen.
• Thaw premixed, frozen solutions at room temperature or in refrigerator.
• Do not immerse in water baths or microwave to thaw.
• After thawing, store refrigerated no longer than 7 days or 24 hr at room temperature.
• Do not refreeze.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess results of AST & ALT, H&H, BUN and creatinine studies at appropriate intervals during therapy.
• Send urine and culture and sensitivity specimens to lab. Therapy may be initiated before results are received, but cultures should be collected prior to drug therapy.
• Request WBC and differential counts prior to initiation of therapy and at least weekly during therapy.
• Perform periodic hemoccult tests on stool.
• Monitor and record skin integrity. Report ecchymosis, bleeding and rashes.
• Assess neurologic status and report lethargy and irritability.
• Assess GI status and report changes in appetite or bowel habits. If patient has diarrhea, consider possibility of pseudomembranous colitis.
• Assess GU status and report hematuria, oliguria and proteinuria.
• Monitor data throughout therapy and report abnormalities to physician.
• Monitor I&O and report imbalances to physician. Ensure adequate fluid intake, especially if client has diarrhea episodes.
• Assess IV site regularly and report signs of vein irritation to physician.
• If pain and induration occur at injection site, apply ice pack.
• Monitor for signs of superinfection.

 Patient/Family Education

• Advise patient to report rash, hives, fever, itching, severe diarrhea, shortness of breath, wheezing, black tongue, sore throat, nausea, vomiting, fever, swollen joints, unusual bleeding or bruising.
• Explain that intermittent urinalysis may be required several months after treatment.
• Tell diabetic patients to use Clinistix or Tes-tape for urine monitoring. Solutions used for urine glucose testing may indicate false-positive results if taking penicillin therapy over period of time.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts