TICARCILLIN DISODIUM/CLAVULANATE POTASSIUM

TICARCILLIN DISODIUM/CLAVULANATE POTASSIUM (tye-kar-sill'in/clav-yoo'la-nate) Timentin Classifications: antibiotic; antipseudomonal penicillin; Therapeutic: antibiotic Prototype: Piperacillin Pregnancy Category: B

Availability

3.1 g injection

Action

Injectable extended-spectrum penicillin and fixed combination of ticarcillin disodium with the potassium salt of clavulanic acid, a beta-lactamase inhibitor. Used alone, clavulanic acid antibacterial activity is weak, but in combination with ticarcillin prevents degradation by beta-lactamase and extends ticarcillin spectrum of activity against many strains of beta-lactamase-producing bacteria (synergistic effect). Synergism between the two drugs does not occur against organisms susceptible to ticarcillin alone.

Therapeutic Effect

Extends ticarcillin spectrum of activity against many strains of beta-lactamase–producing bacteria (synergistic effect).

Uses

Infections of lower respiratory tract and urinary tract and skin and skin structures, infections of bone and joint, and septicemia caused by susceptible organisms. Also mixed infections and as presumptive therapy before identification of causative organism.

Contraindications

Hypersensitivity to penicillins or to cephalosporins, coagulopathy.

Cautious Use

Pregnancy (category B); diabetes mellitus; GI disease; asthma; history of allergies; renal impairment.

Route & Dosage

Moderate to Severe Infections Adult: IV >60 kg, 3.1 g q4–6h Child: IV >3 mo, 200–300 mg/kg/d divided q4–6h (based on ticarcillin) Infant: IV <3 mo, 200–300 mg/kg/d divided q6–8h (based on ticarcillin) Renal Impairment Clcr 30–60 mL/min: give 2 g q4h or 3.1 g q8h; 10–30 mL/min: give 2 g q8h or 3.1 g q12h; <10 mL/min: give 2 g q12h Hemodialysis: 2 g q12h, supplement with 3.1 g after dialysis

Administration

Intravenous Note: Verify correct IV concentration and rate of infusion for administration to infants and children with physician. PREPARE: Intermittent: • Reconstitute by adding to 3.1 g of powder 13 mL sterile water for injection or NS injection to yield 200 mg/mL ticarcillin with 6.7 mg/mL clavulanic acid. Shake until dissolved. • Further dilute with NS, D5W, or RL to concentrations between 10–100 mg/mL.• DO NOT use if discoloration or particulate matter is present.  ADMINISTER: Intermittent: Give over 30 min.   INCOMPATIBILITIES Solution/additive: aminoglycosides, sodium bicarbonate. Y-site: aminoglycosides, amphotericin B cholesteryl complex, azithromycin, vancomycin.

• Store vial with sterile powder at 21°–24° C (69°–75° F) or colder. If exposed to higher temperature, powder will darken, indicating degradation of clavulanate potassium and loss of potency. Discard vial. See package insert for information about storage and stability of reconstituted and diluted IV solutions of drug.

Adverse Effects (≥1%)

Body as a Whole: Hypersensitivity reactions, pain, burning, swelling at injection site; phlebitis, thrombophlebitis; superinfections. CNS: Headache, blurred vision, mental deterioration, convulsions, hallucinations, seizures, giddiness, neuromuscular hyperirritability. GI: Diarrhea, nausea, vomiting, disturbances of taste or smell, stomatitis, flatulence. Hematologic: Eosinophilia, thrombocytopenia, leukopenia, neutropenia, hemolytic anemia. Metabolic: Hypernatremia, transient increases in serum AST, ALT, BUN, and alkaline phosphatase; increases in serum LDH, bilirubin, and creatinine and decreased serum uric acid.

Diagnostic Test Interference

May interfere with test methods used to determine urinary proteins except for tests for urinary protein that use bromphenol blue. Positive direct antiglobulin (Coombs') test results, apparently caused by clavulanic acid, have been reported. This test may interfere with transfusion cross-matching procedures.

Interactions

Drugs: May increase risk of bleeding with anticoagulants; probenecid decreases elimination of ticarcillin.

Pharmacokinetics

Distribution: Widely distributed with highest concentrations in urine and bile; crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: In urine. Half-Life: 1.1–1.2 h ticarcillin, 1.1–1.5 h clavulanate.

Nursing Implications

Assessment & Drug Effects

• Lab tests: Obtain baseline C&S tests before initiating therapy; drug may be started pending results. Monitor kidney and liver functions, CBC, platelet count, and serum electrolytes during prolonged treatment.
• Be aware that serious and sometimes fatal anaphylactoid reactions have been reported in patients with penicillin hypersensitivity or history of sensitivity to multiple allergens. Reported incidence is low with this combination drug.
• Monitor cardiac status because of high sodium content of drug.
• Overdose symptoms: This drug may cause neuromuscular hyperirritability or seizures.

Patient & Family Education

• Report urticaria, rashes, or pruritus to physician immediately.
• Report frequent loose stools, diarrhea, or other possible signs of pseudomembranous colitis (see Appendix F) to physician.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug