Ticarcillin and Clavulanate

As a combination antibiotic, Ticarcillin and clavulanate is used to treat a wide spectrum of issues with increased efficacy.

Overview:

Ticarcillin is a penicillin derivative antibiotic which fights bacteria within the body. Clavulanate is type of clavulanic acid, which is similar in many respects to penicillin. When combined, the pair are effective at treating infections which have otherwise become resistant to penicillin.

Ticarcillin and clavulanate helps patients to overcome serious infectious diseases, and is typically used to fight septicemia, lower respiratory infections, UTIs and infections of the skin, bones and joints. Combining the two antibiotics into one intravenous injection provides a boost to the efficacy, which is useful when bacteria has developed an increased immunity to either medication.

In addition to fighting the aforementioned illnesses, Ticarcillin and clavulanate can be used to dispel symptoms of certain sexually-transmitted gynaecologic infections, as well as being effective in treating bacteria-based food poisoning such as E. coli. By fighting off bacteria associated with all manner of infections, combined doses of ticarcillin and clavulanate make the recovery process quicker and easier, thereby helping the patient to return to functioning normally in their daily life in a matter of weeks.

Conditions treated:

  • Septicemia
  • Lower respiratory infections
  • Bone & joint infections
  • Skin infections
  • Intra-abdominal infections
  • Urinary tract infections
  • Gynecologic infections

Type of medicine

  • Antibiotic

Side effects:

The most common side effects reported by patients receiving treatment with a combined course of intravenous ticarcillin and clavulanate include mild diarrhea, bruising, feeling unusually weak or tired, increased thirst, dry mouth, vaginal yeast infection, headaches and/or a skin rash.

As the patient continues with a course of the medication as prescribed, the majority (if not all) of these effects and their symptoms should decrease. Minor symptoms such as increased thirst or dry mouth can be combatted by simply sucking on sugar-free rock candy, chewing sugar free gum or taking frequent drinks of cold water.

Most patients will only experience minimal side effects when receiving an intravenous course of ticarcillin and clavulanate, if any whatsoever. In many instances the medicine will alleviate symptoms which are often confused with side effects, resulting in them dissipating over the period of treatment.

However, some side effects have the propensity to cause serious issues. If you experience any of the following symptoms, you should consult a doctor or qualified healthcare professional who will be able to offer advice. In some instances, a doctor may recommend ceasing treatment and switching to another form of antibiotic if practical, or if side effects are too severe:

  • Acute headaches
  • Pain, swelling or burning at the injection site
  • Severe skin rash or itching

In exceptionally rare circumstances, the combined use of ticarcillin and clavulanate may have the propensity to affect the psychology of the patient, who could potentially experience mood swings, hallucinations, memory problems and confusion. It is therefore advised that patients undergoing treatment with these medicines avoid driving or operating heavy machinery in the early stages of drug use, until it is ascertained that it is safe for the patient to do so.

In equally rare instances, some patients have reported hypersensitive reactions including chest discomfort, chills, myalgia, Stevens-Johnson syndrome, urticaria, toxic epidermal necrolysis and anaphylactic reactions. Although the risk of hypersensitive reaction is rare, healthcare providers should have access to anti-anaphylaxis medications in order to counteract potentially fatal side effects.

Dosage

As with all medicines, it is important to only take an intravenous combination as prescribed by a healthcare professional. This ultimately means that patients should only take the prescribed dose (if self-administering), or (as is more likely) be given the dosage in a clinical setting as directed by a physician. Patients should only be provided with a dose of ticarcillin combined with clavulanate on the frequency agreed upon by the doctor, and should cease treatment with the medicine when instructed to – even if they still have medication remaining.

For systemic infections, adults and children who weigh greater than 60kg should be provided with 3.1g of the combined medication intravenously every four to six hours. Those weighing less than 60kg should be given 200mg to 300mg intravenously over the course of a day, in divided doses (typically every four to six hours) as decided by a physician.

For severe gynecologic infections, a dose of 300mg per day every four to six hours is recommended. As infection subsides, this can be tapered down to 200mg per day until the infection has been defeated completely.

As this medicine is typically administered by a healthcare professional in a clinical setting, most patients will not have to worry about the general advice surrounding the IV use of ticarcillin and clavulanate. The solution should be visually inspected by the administering professional before administration. If the solution is cloudy, discolored or appears to contain particulate matter, it should be discarded.

The prescribed dose can be administered over a 30-minute period via direct infusion, although a Y-type infusion can be used if there is one already in place. If a Y-type intravenous infusion is used, the administration of other solutions should be discontinued during the infusion of ticarcillin and clavulanate.

Patients with renal impairment may require an adjusted dose. It is recommended that patients with renal impairment receive the standard dose if infection is severe (3.1g intravenously, in divided doses every 4-6 hours) with a reduced maintenance dose based on the creatinine clearance of the patient.

Patients with hepatic impairment are advised to receive no more than 2g of ticarcillin and clavulanate per 24 hours, although this is dependent on the opinion of the doctor overseeing treatment. In some instances, short-period treatment with antibiotics may outweigh the risks in those with liver issues, and a physician may determine it is safe to undergo treatment with the standard dose of 3.1g per day.

Treatment duration will vary based on the physiology of the patient and the severity of the infection, but most patients who require an intravenous course of ticarcillin and clavulanate will do so for at least 10-14 days. Those suffering from difficult or complicated infections may require more prolonged therapies or combined therapies in order to return to pre-infection conditions.

In the event of an overdose outside of a clinical setting, patients who experience extremely fast or slow heartbeat, difficulty breathing, major co-ordination loss or hypersensitive reactions are urged to seek out urgent emergency attention by calling the emergency services on 991 or the poison control center on 1800-222-1222. Overdose of ticarcillin and clavulanate, although rare, can be harmful and potentially fatal, which is why it is important to seek immediate help.

Interactions:

All drugs have the potential to interact with other drugs or chemicals already present in the body. These interactions can change the way in which medications work, and can even cause unwanted side effects, or increase the level of currently experienced side effects. Because of this risk, it is imperative that patients keep a detailed list of all medicines they are currently taking, including over the counter remedies, herbal supplements and vitamins.

Below is a list of the types of medicine and brands of medicine known to interact with ticarcillin and clavulanate. If you are currently undergoing treatment with one or more of these, you should inform your doctor prior to engaging in antibiotic treatment:

  • Anticoagulants – can cause increased bleeding risk when used in conjunction with ticarcillin and clavulanate.
  • Oral contraceptives – the efficacy of certain oral contraceptives may be reduced when taken in conjunction with ticarcillin and clavulanate. Patients are advised to use additional forms of contraception or to abstain from sexual intercourse during treatment.
  • Tetracyclines – combined use of these with ticarcillin and clavulanate may impair the bactericidal effects of the antibiotic.
  • Heparin - can cause increased bleeding risk when used in conjunction with ticarcillin and clavulanate.
  • Probenicid – can cause increased levels of ticarcillin, leading to increased side effects or discomfort.
  • Erythromycin – antagonism or synergism can potentially develop when this medicine is combined with ticarcillin and clavulanate.
  • Sodium bicarbonate – this solution is not compatible with ticarcillin and clavulanate; it is therefore not recommended as a diluent.

Patients who are allergic to penicillin or any other type of penicillin antibiotic (such as amoxicillin, ampicillin, carbenicillin, dicloxacillin or oxacillin) should avoid treatment with ticarcillin and clavulanate. A qualified physician will be able to advise an alternate course of treatment.

Warnings:

As with all anti-bacterial agents, ticarcillin and clavulanate have the potential to cause C. diff associated diarrhea. Care should be taken if outside of a clinical environment. A doctor may prescribe anti-diarrhea medication or additional fluids during treatment with this medicine.

In some patients, seizures and convulsions have been reported when the prescribed dose has been exceeded – particularly in patients suffering from renal impairment. An increased risk of bleeding is also associated with patients with renal conditions.

Like all antibiotics, increased used of ticarcillin and clavulanate is associated with microbial overgrowth and bacterial resistance. It is therefore advised that patients only use antibiotics when completely necessary. If possible, other avenues of treatment should first be investigated, particularly if the infection is minor or moderate.

The FDA has categorized ticarcillin and clavulanate as Pregnancy Category B substances. This means that studies have showed that use of these antibiotics pose little or no risk when passed in utero to a fetus, and pose little or no risk in the event of the medication being excreted in breastmilk.

Storage:

Prepared intravenous solution with ticarcillin and clavulanate can be refrigerated or frozen in order to prolong its life. At refrigerated temperature (2C to 8C) it will remain stable for up to seven days. When frozen, it will remain stable for up to 30 days before it needs to be reconstituted. When the solution begins to darken, this is an indicator that it is losing potency. At room temperature, the solution is only stable for a period of six hours.

Summary

Ticarcillin as an effective, broad-scale treatment for a variety of different bacterial infections. Because it is a penicillin derivative, it is not suitable for those with allergies to the antibiotic. Ticarcillin is roughly 45 per cent protein bound, whereas clavulanate is roughly 25 per cent protein bound.

When the two compounds are combined this can increase the efficacy of one or both, and this is useful in fighting infection against antibiotic-resistant bacteria including E. coli and certain strains of pneumonia. This combination of medications is currently approved in the US for children greater than three months of age, and it is used around the world in the treatment of sepsis and other infections in both infants and adults.

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Last Reviewed:
December 22, 2017
Last Updated:
December 22, 2017
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