Ticarcillin (Ticarcillin Disodium)

A to Z Drug Facts

Ticarcillin (Ticarcillin Disodium)

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(TIE-car-sill-in)

Ticar

Powder for Injection: 3 g

Class: Antibiotic, Penicillin

Action Inhibits bacterial cell wall mucopeptide synthesis.

Indications Treatment of bacterial septicemia, skin and soft tissue infections, acute and chronic respiratory tract infections, GU tract infections and infections caused by susceptible strains of anaerobic bacteria, Pseudomonas aeruginosa, Proteus species, and Escherichia coli .

Contraindications Hypersensitivity to penicillins.

Route/Dosage

Bacterial Septicemia, Respiratory Tract Infections, Skin and Soft Tissue Infections, Intra-Abdominal Infections, and Infections of the Female Pelvis and Genital Tract

Adults and Children: IV 200 to 300 mg/kg/day in divided doses q 4 to 6 hr. In adults, the usual dose is IV 3 to 4 g q 4 to 6 hr.

Complicated UTIs

Adults and Children: IV 150 to 200 mg/kg/day in divided doses q 4 to 6 hr (usual dose for 70 kg adult is 3 g qid).

Uncomplicated UTIs

Adults: IM/IV 1 g q 6 hr. Children weighing less than 40 kg: IM/IV 50 to 100 mg/kg/day in divided doses q 6 to 8 hr.

Severe infections (sepsis) caused by susceptible strains of Pseudomonas sp., Proteus sp., and E. coli

Neonates: IM/IV Weighing less than 2 kg and less than 7 days of age: 75 mg/kg q 12 hr. Weighing less than 2 kg and more than 7 days of age: 75 mg/kg q 8 hr. Weighing 2 kg or more and less than 7 days of age: 75 mg/kg q 8 hr. Weighing 2 kg or more and more than 7 days of age: 100 mg/kg q 8 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 therapy. Erythromycin: Synergism or antagonism may develop. Heparin: May increase bleeding risks of heparin by prolonging bleeding time. Probenecid: May increase ticarcillin concentration. Tetracyclines: May impair bactericidal effects of ticarcillin. Aminoglycosides, parenteral: May inactivate aminoglycosides in vitro; do 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 (eg, Clinistix, Tes-tape); false-positive direct Coombs' test result in certain patient groups; 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

CARDIOVASCULAR: Phlebitis; vein irritation; deep vein thrombosis. CNS: Neurotoxicity (eg, lethargy, neuromuscular irritability, hallucinations, convulsions, seizures). DERMATOLOGIC: Rash; pruritis; urticaria. EENT: Itchy eyes. GI: Nausea; vomiting; diarrhea or bloody diarrhea; pseudomembranous colitis. GU: Elevated creatinine or BUN; vaginitis. HEMATOLOGIC: Anemia; hemolytic anemia; thrombocytopenia; thrombocytopenic purpura; eosinophilia; leukopenia; granulocytopenia; neutropenia; bone marrow depression; prolongation of bleeding and prothrombin time; increase in platelets. HEPATIC: Transient hepatitis (elevated AST). METABOLIC: Elevated serum alkaline phosphatase; hypernatremia; reduced serum potassium. OTHER: Hypersensitivity reactions; hyperthermia; pain at site of injection; hematomas.

Precautions

Pregnancy: Category B. Lactation: Excreted in breast milk. Bleeding abnormalities: Hemorrhagic manifestations associated with abnormalities of coagulation tests (eg, 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 drug with caution to cephalosporin-sensitive patients because of possible crossreactivity. Pseudomembranous colitis: May occur because of overgrowth of clostridia. Renal insufficiency: Dosage and interval adjustments are necessary. Sodium content: Contains 4.7 to 5 mEq sodium/g. Superinfection: May result in bacterial or fungal overgrowth of nonsusceptible organisms.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Reconstitute with sterile water, sodium chloride or 1% lidocaine HCl solution (without epinephrine) to obtain 1 g ticarcillin/2.6 mL solution.
Use promptly after reconstitution.
Inject into relatively large muscle.
Do not exceed 1 g/injection.

Do not mix gentamicin, amikacin, or tobramycin in same IV solution.
Administer slowly over 30 min to 2 hr to avoid vein irritation.
To reconstitute, add 4 mL of sodium chloride injection, dextrose injection 5%, or lactated ringer's injection to each gram of ticarcillin powder to obtain 200 mg/mL. When dissolved, dilute further to desired volume.
Reconstitute 3 g piggyback bottles with minimum of 30 mL of desired IV solution. A dilution of no more than 50 mg/mL will reduce incidence of vein irritation.
After reconstitution, ticarcillin may be stored frozen for up to 30 days.
Store IV solutions mixed in sodium chloride or dextrose no longer than 72 hr at room temperature or 14 days under refrigeration.
Store IV solutions mixed in Ringer's solution no longer than 48 hr at room temperature or 14 days under refrigeration.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies.
Obtain urine and culture and sensitivity specimens and send to lab. Therapy may be initiated before results are received, but collect cultures prior to drug therapy.
Request WBC and differential counts prior to initiation of therapy and at least weekly during therapy.
Request AST, ALT, H&H, BUN, and creatinine studies at appropriate intervals 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.
Assess GU status and report hematuria, oliguria, and proteinuria.
Monitor lab results and report abnormal H&H, potassium, WBC and differential counts, blood coagulation tests, and LFTs.
Monitor results of culture and sensitivity to ensure bacteria is sensitive to ticarcillin.
Monitor IV site and report signs of vein irritation.
Monitor I&O and report imbalances. Ensure adequate fluid intake, especially if patient has diarrhea episodes.
Apply ice pack if pain and induration occur at injection site.
Monitor for signs of superinfection.

OVERDOSAGE: SIGNS & SYMPTOMS
	May result in neuromuscular hyperexcitability or seizures

Patient/Family Education

Advise patient to report rash, hives, fever, itching, severe diarrhea, shortness of breath, wheezing, black tongue, sore throat, nausea, vomiting, swollen joints, unusual bleeding, or bruising.
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.