ticarcillin (Ticar)

Introduction

Tradename: Ticar. 4th generation penicillin.

Indications

• bacterial infections due to susceptible organisms
• anaerobic infection
• abscess
  • brain abscess
  • pulmonary abscess
  • pelvic abscess
• parapneumonic effusion
• chronic suppurative otitis media
• intra-abdominal infection
  • cholangitis
• urogenital infection
  • urinary tract infection
  • salpingitis
  • pelvic inflammatory disease
• skin or soft tissue infection
• infectious arthritis, osteomyeltitis

Dosage

3-4 g IV/IM every 3-6 hours

Pediatrics: 200-300 mg/kg/day divided every 4-6 h.

Dosage adjustment in renal failure

Table

creatinine clearance	dosage
> 50-90 mL/min	1-2 g every 4 hours
10-50 mL/min*	1-2 g every 8 hours
< 10 mL/min#	1-2 g every 12 hours

* same dose for continuous arteriovenous hemofiltration

# extra 3 g after hemodialysis

Pharmacokinetics

• elimination 1/2life 1.2 hours (13 hours ESRD)

elimination via kidney

elimination via liver

1/2life = 1.2 hours

protein binding = 45-65 %

elimination by hemodialysis = +/-

Antimicrobial activity

Gram positive

• Streptococcus
  • Streptococcus group A
  • Streptococcus group B
  • Streptococcus group C
  • Streptococcus group G
• Streptococcus pneumonia
• Streptococcus viridans, milleri
• Enterococcus faecalis (+/-)
• Enterococcus faecium (+/-)
• Staphylococcus epidermidis (+/-)
• Listeria monocytogenes

Gram negative

• Neisseria gonorrhoeae
• Neisseria meningitidis
• Haemophilus influenzae (+/-)
• Escherichia coli (+/-)
• Enterobacter species
• Serratia species
• Salmonella species
• Shigella species
• Proteus mirabilis
• Proteus vulgaris
• Providencia species
• Morganella species
  • Morganella morganii
• Citrobacter species
• Aeromonas species
• Pseudomonas aeruginosa
• Yersinia enterocolitica (+/-)
• Pasteurella multocida
• Klebsiella penumoniae

Anaerobes

• Bacteroides fragilis (+/-)
• Bacteroides melaninogenicus
• Clostridium species
• Peptostreptococcus species

Adverse effects

• hypersensitivity
• hepatotoxicity
• electrolyte & acid-base disturbances
• reversible granulocytopenia
• neurotoxicity

Drug interactions

• probenecid delays renal secretion of ticarcillin

• drug interaction(s) anticonvulsants with anti-bacterial agents
• drug interaction(s) of antibiotics with warfarin

Laboratory

• specimen: serum, plasma (heparin, EDTA)
• methods: MB, HPLC

More general terms

• 4th generation penicillin (extended-spectrum)

Component of

• ticarcillin clavulanate (Timentin)

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=656842
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=104960
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=36921
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=20823
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=104961
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=470375
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=161632
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=5471