ticarcillin/clavulanate (Rx)
Generic: Ticarcillin/clavulanate
Brand: Timentin
(tye-kar-sill'in)
Pharmacological Action
Interferes with cell wall replication of susceptible organisms; osmotically unstable cell wall swells, bursts from osmotic pressure; clavulanate inhibits b-lactamase and protects against enzymatic degradation of ticarcillin
Therapeutic outcome: Resolution of infection
Uses
Respiratory, soft tissue, urinary tract infections; bacterial septicemia; effective for gram-positive cocci (Staphylococcus aureus, Streptococcus faecalis, Streptococcus pneumoniae), gram-negative cocci (Neisseria gonorrhoeae), gram-positive bacilli (Clostridium perfringens, Clostridium tetani), gram-negative bacilli (Bacteroides, Fusobacterium nucleatum, Escherichia coli, Proteus mirabilis, Salmonella, Morganella morganii, Proteus rettgeri, Enterobacter, Pseudomonas aeruginosa, Serratia, Peptococcus, Peptostreptococcus, Eubacterium)
Contraindications
Hypersensitivity to penicillins; neonates
Precautions: Pregnancy B, hypersensitivity to cephalosporins, renal disease
Dosage & Routes
Systemic/urinary tract infections, moderate/severe infections Adult ≥60 kg: IV INF 3.1 g q4-6 hr Adult <60 kg: IV INF 200-300 mg/kg/day q4-6 hr Child >60 kg: IV INF 3.1 g q4 hr Child <60 kg: IV INF 300 mg/kg/day q4 hr Full-term neonate/infant <3 mo (unlabeled): IV 50 mg/kg q4 hr Mild/moderate infections Child ≥60 kg: IV INF 3.1 g q6 hr Child <60 kg: IV INF 200 mg/kg/day q6 hr Full-term neonate/infant <3 mo (unlabeled): IV 50 mg/kg q6 hr Renal dose
Adult: IV INF loading dose 3.1 g; CCr 60 ml/min 3.1 g q4 hr; CCr 30-60 ml/min 2 g q4 hr; CCr 10-30 ml/min 2 g q8 hr; CCr <10 ml/min 2 g q12 hr; CCr <10 ml/min with hepatic dysfunction 2 g q24 hr
Available forms: Inj IM, IV 3 g ticarcillin and 0.1 g clavulanate; IV inf 3 g ticarcillin and 0.1 g clavulanate; powder for inj 3 g ticarcillin, 0.1 g clavulanate
Implementation - Give product after C&S has been completed, give ≥q1 hr before bactericidal antiinfectives, change IV site q48 hr - Have adrenalin, suction, tracheostomy set, endotracheal intubation equipment available - Obtain scratch test results to assess allergy after securing order from prescriber; usually done when penicillin is only product of choice - Store at room temperature, reconstituted sol for 12-24 hr or 3-7 days refrigerated Intermittent IV infusion route - Give IV after diluting 3.1 g or less/13 ml of sterile water or 0.9% NaCl (200 mg/ml), shake; may further dilute in 50-100 ml or more 0.9% NaCl, D5 W, or LR and run over ½ hr
Y-site compatibilities: Allopurinol, amifostine, amikacin, anidulafungin, atropine, aztreonam, bivalirudin, bumetanide, ceFAZolin, cefepime, cefotaxime, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, cimetidine, clindamycin, cyclophosphamide, cycloSPORINE, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOCEtaxel, DOPamine, DOXOrubicin liposome, doxycycline, enalaprilat, EPINEPHrine, esmolol, etoposide phosphate, famotidine, fenoldopam, filgrastim, fluconazole, furosemide, gemcitabine, gentamicin, granisetron, heparin, hydrocortisone, HYDROmorphone, imipenem/cilastatin, insulin, isoproterenol, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, melphalan, meperidine, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, milrinone, morphine, nitroglycerin, nitroprusside, norepinephrine, ondansetron, palonosetron, pantoprazole, PEMEtrexed, penicillin G potassium, perphenazine, phenylephrine, procainamide, propofol, propranolol, ranitidine, remifentanil, sargramostim, sodium bicarbonate, tacrolimus, teniposide, theophylline, thiotepa, tirofiban, tobramycin, vasopressin, verapamil, vinorelbine, voriconazole Y-site incompatibilities: Acyclovir, amphotericin B cholesteryl sulfate, azithromycin, caspofungin, diazepam, DOBUTamine, drotrecogin, erythromycin, ganciclovir, haloperidol, hydrOXYzine, lansoprazole, phenytoin, promethazine, protamine, quinupristin/dalfopristin, trimethoprim/sulfamethoxazole
Adverse Effects
CNS: Anxiety, coma, seizures, confusion, drowsiness
GI: Nausea, vomiting, diarrhea, increased AST, ALT, abdominal pain, glossitis, colitis, pseudomembranous colitis, hepatotoxicity
HEMA: Anemia, increased bleeding time, bone marrow depression, granulocytopenia
INTEG: Rash, urticaria, toxic epidermal necrolysis, pain at injection site
META: Hypokalemia, hypernatremia
SYST: Anaphylaxis, Stevens-Johnson syndrome, overgrowth of organisms
Pharmacokinetics
Absorption: Completely absorbed (IV)
Distribution: Widely distributed, crosses blood-brain barrier
Metabolism: Liver
Excretion: Kidneys
Half-life: 64-68 min
Pharmacodynamics
IV: Onset Unknown, Peak 30-45 min, Duration 4 hr
Interactions
Individual drugs
Chloramphenicol: decreased antimicrobial effect of ticarcillin
Heparin: increased effect of heparin
Methotrexate: increased methotrexate level Probenecid, sulfinpyrazone: increased ticarcillin concentration
Drug classifications Aminoglycosides (IV): decreased antimicrobial effect of ticarcillin
Anticoagulants: increased bleeding Contraceptives (oral): decreased effect of oral contraceptives
Erythromycins: decreased absorption Macrolides, sulfonamides, tetracyclines: decreased ticarcillin effect
Drug/lab test
Increased: LFTs, sodium, eosinophils, INR, bleeding time, uric acid, bilirubin, BUN, creatinine, alk phos, LDH
Decreased: Hgb, potassium, platelets, WBC, granulocytes False positive: urine glucose, urine protein, Coombs' test
Nursing Considerations
Assessment -
Infection: WBC, wound, temperature, sputum, urine, baseline and periodically - Pseudomembranous colitis: assess for diarrhea, abdominal pain, fever, fatigue, anorexia; possible anemia, elevated WBC, low serum albumin; stop product and usually give either vancomycin or IV metroNIDAZOLE - Monitor liver function tests: AST, ALT - Monitor blood tests: WBC, RBC, Hgb, Hct, bleeding time, platelets, baseline and periodically - Monitor renal function tests; sodium, potassium - Assess bowel pattern before, during treatment - Assess skin eruptions after administration of penicillin to 1 wk after discontinuing product - Assess for anaphylaxis: wheezing, rash, laryngeal edema; have emergency equipment nearby - Serious skin reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis
Patient/family education - Advise patient that C&S may be performed after completed course of medication - Instruct patient to report sore throat, fever, fatigue (may indicate superinfection) - Advise patient to carry/wear emergency ID if allergic to penicillins - Advise patient to use alternative birth control methods instead of hormonal - Advise patient to report persistent diarrhea with blood, pus, mucus, or fever
Evaluation
Positive therapeutic outcome: Absence of fever, purulent drainage, redness, inflammation TREATMENT OF
OVERDOSE: Withdraw product, maintain airway, administer EPINEPHrine, aminophylline, O2, IV corticosteroids for anaphylaxis
Reference
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