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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

TIMENTIN
(Ticarcillin/Clavulanic acid)

Indication

  • Timentin is reserved for the treatment of infections which are caused by susceptible Gram-negative bacteria which are ampicillin resistant
  • Stenotrophomonas maltophilia: this is an aerobic, Gram-negative bacillus; antibiotic susceptibility studies and clinical observation suggest that the most active antibiotics against S.maltophilia are TMP-SMX (Septra) and ticarcillin/clavulanic acid (Timentin)
  • in general, Timentin should NOT be used for the treatment of Gram-positive organisms, since other agents (eg. Penicillin, Ampicillin) are more appropriate

Pharmacology

  • ticarcillin is a semisynthetic extended-spectrum penicillin
  • clavulanic acid is an inhibitor of certain Beta - lactamases.
  • ticarcillin is active in vitro against many Gram-positive aerobic cocci (including group B streptococci), Gram-negative aerobic cocci (including enterobacteriaceae, Pseudomonas) and anaerobic bacteria (including some strains of Bacteroides);
  • clavulanic acid expands the spectrum of ticarcillin to include beta-lactamase producing strains of S aureus, H influenzae, Moraxella catarrhalis, B fragilis, Klebsiella and Proteus species
  • the antibacterial activity of ticarcillin and aminoglycosides may be additive or synergistic against some strains of Pseudomonas aeruginosa
  • ticarcillin is well distributed throughout most body tissues and fluids; high levels are not attained in the CSF, although CSF levels are generally higher when the meninges are inflamed
  • Serum half life

    Ticarcillin
    < 7 days old : 3.5 - 5.6 hours
    1 to 8 weeks : 1.3 - 2.2 hours

    Clavulanic acid
    4.4 hours ('neonates')

  • elimation
    • Ticarcillin
      almost entirely eliminated in the urine as unchanged drug
    • Clavulanic acid
      metabolized in the liver

Side Effects

  • hypersensitivity reactions (rare in the neonate)
  • hematologic effects (rare)
  • GI effects (vomiting, loose stools, diarrhea)
  • local reactions (vein irritation, pain, erythema, phlebitis)
  • transient increases in serum levels of liver enzymes have been reported
  • when used in anti-Pseudomonal doses ticarcillin can interfere with platelet aggregation, which may promote bleeding; this effect appears to be related to the dose and the duration of therapy

Dose

  • administer slow IV infusion over 30 minutes
  • extend dosing interval in renal or renal + hepatic impairment

    Dose: 75 to 100mg/kg (see chart for doing interval)

    Ticarcillin/clavulanic acid dosing chart
    (based on ticarcillin component)
    Gestational Age
    (weeks)
    Post Natal Age
    (days)
    Interval
    (hours)
    <29
    0 to 28
    >28
    12
    8
    30 to 36
    0 to 14
    >14
    12
    8
    37 to 44
    0 to 7
    >14
    12
    8
    >45
    ALL
    6

    Reference: Neofax (Palm version) 24 December 2002

Supplied

  • 50 mg/mL (ticarcillin component) syringe for IV use prepared by the Department of Pharmacy
  • Timentin 3.1g vial (Ticarcillin 3g and Clavulanic acid 0.1g)

    reconstitute as follows:

    1. Reconstitute Timentin 3.1 g vial with 13mL sterile water for injection (SWFI) to produce ticarcillin 200 mg/mL
    2. Take 1 mL of the 200 mg/mL solution plus 3 mL SWFI
                = 200 mg / 4 mL
                = 50 mg / mL

References

  1. McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 2001.
  2. Taketomo CK, Hodding JH and Kraus DM: Pediatric Dosage Handbook, Lexi-Comp Inc., Cleveland, 7th Edition, 2000-2001
  3. Phelps SJ, Hak EB: Guidelines for administration of intravenous medications to pediatric patients, American Society of Hospital Pharmacists, Bethesda, MD, 5th Edition, 1996.
  4. Sattler CA : Stenotrophomonas maltophilia infection in children, Pediatr Infect Dis J 2000;19:877-8.

Date of preparation : 30 March 2001


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