Ticarcillin

Ticarcillin belongs to the pharmacological class of Beta-Lactam Antibiotics.

Ticarcillin has been approved to relieve symptoms and also for the treatment and maintenance of urinary tract infections, intra-abdominal infections, septicemia, lower respiratory infections, bone & joint Infections, skin & skin structure infections, gynecologic infections,renal Impairment.

Ticarcillin is not absorbed from the Gastrointestinal tract. Ticarcillin is found to be widely distributed. The plasma half-life of Ticarcillin is 70 min; 50 min (patients with cystic fibrosis). Ticarcillin is said to have a limited metabolism. Ticarcillin is excreted up to 90% excreted unchanged in the urine.

The common side effects involving the use of Ticarcillin are nausea, vomiting, headache, diarrhea, headache, upset stomach, etc.

Ticarcillin is available in the form of Intramuscular and Intravenous.

Ticarcillin is approved in the U.S., U.K., Germany, Japan, Malaysia, India, and China.

Ticarcillin belongs to the pharmacological class of Beta-Lactam Antibiotics.

Ticarcillin is the pivaloyloxymethyl ester of mecillinam. It interferes with the bacterial cell wall with its high specificity against the penicillin-binding protein 2 (PBP-2), making it different from other penicillins.

Ticarcillin has been approved to relieve symptoms and also for the treatment and maintenance of urinary tract infections, intra-abdominal infections, septicemia, lower respiratory infections, bone & joint Infections, skin & skin structure infections, gynecologic infections, renal Impairment.

The Peak plasma concentration of Ticarcillin is found to be 0.5-1 hr when administered Intramuscularly.

Ticarcillin is available in the form of Intramuscular and Intravenous.

Ticarcillin can be used in the following treatment:

• Urinary Tract Infections
• Intra-abdominal Infections
• Septicemia
• Lower Respiratory Infections
• Bone & Joint Infections
• Skin & Skin Structure Infections
• Gynecologic Infections
• Renal Impairment

Ticarcillin can help to relieve symptoms and also for the treatment and maintenance of urinary tract infections, intra-abdominal infections, septicemia, lower respiratory infections, bone & joint Infections, skin & skin structure infections, gynecologic infections, renal Impairment.

Ticarcillin is approved for use in the following clinical indications:

• Urinary Tract Infections
• Intra-abdominal Infections
• Septicemia
• Lower Respiratory Infections
• Bone & Joint Infections
• Skin & Skin Structure Infections
• Gynecologic Infections
• Renal Impairment

Intravenous

Severe Gram-negative infections, Skin infections, Septicaemia, Peritonitis, Bone and joint infections

Adult: 200-300 mg/kg daily by infusion in divided doses every 4 or 6 hr.

Child: 200-300 mg/kg by infusion in divided doses every 4 or 6 hr.

Parenteral

Complicated urinary tract infections

Adult: 150-200 mg/kg daily by Intravenous infusion in divided doses every 4 or 6 hr.

Child: 150-200 mg/kg daily by Intravenous infusion in divided doses every 4 or 6 hr.

Parenteral

Uncomplicated urinary tract infections

Adult: 1 g Intramuscular/slow Intravenous Injection every 6 hr.

Child: 50-100 mg/kg in divided doses every 6-8 hr. Do not inject >2 g into each Intramuscular site.

Ticarcillin is available in 1 g, 3 g, powder for reconstitution and 20 g, 30 g ready to use Intravenous vials.

Intramuscular and Intravenous

• Dosage Adjustments in Kidney Patients:

Intravenous:

Peritoneal dialysis patients and Complicated urinary tract infections:

3 g every 12 hr; hemodialysis patients: 2 g every 12 hr plus an additional dose of 3 g after each dialysis session.

CrCl (mL/min) <10 Initial IV loading dose of 3 g, followed by 2 g every 12 hr (or 1 g IM every 6 hr).

CrCl (mL/min) <10 with hepatic impairment Initial IV loading dose of 3 g, followed by 2 g IV every 24 hr or 1 g IM every 12 hr.

CrCl (mL/min)10-30: Initial IV loading dose of 3 g, followed by 2 g every 8 hr.

CrCl (mL/min)30-60: Initial IV loading dose of 3 g, followed by 2 g every four hr.

• Dosage Adjustments in Pediatric Patients:

Children and Adolescents Oral: 3 to 6.25 mg/kg/dose every 6 hours; maximum dose: 250 mg/dose.

Avoid high-acid foods like citrus fruits and juices like orange and grapefruit, soda, and chocolates.

Alcohol intake might lead to nausea, vomiting, and headache.

Multivitamins and antacids contain minerals, primarily magnesium, calcium, aluminum, iron, or zinc, which bind to the antibiotic and refrain it from working. Spacing them at least for 2 hours after Ticarcillin administration is recommended.

Ticarcillin may is contraindicated under the following conditions:

• Patients with known hypersensitivity to Penicillin derivatives and cephalosporins.

The physician should closely monitor the patients and keep pharmacovigilance as follows:

Sensitivity

Serious as well as occasionally fatal hypersensitivity (anaphylactoid) reactions have been reported in patients receiving penicillin. The reactions are more likely to occur in persons with a history of sensitivity to multiple allergens. Before therapy with Ticarcillin, a careful inquiry should be made with the patients concerning previous hypersensitivity reactions to penicillins, cephalosporins/ other allergens. If an allergic reaction occurs, the administration of Ticarcillin should be discontinued and appropriate therapy instituted. The possibility of superinfections with mycotic or the bacterial pathogens should be kept in mind during the therapy. If superinfections, usually involving Pseudomonas or Candida, or hypersensitivity reactions occur, the Ticarcillin should be discontinued and/or appropriate therapy instituted.

Susceptibility/Resistance Development of Drug-Resistant Bacteria

Prescribing Ticarcillin in the absence of a proven or strongly suspected bacterial infection which is unlikely to provide benefit to the patient and risks the development of drug-resistant bacteria.

Usage of alcohol should be avoided while on Ticarcillin medication, as alcohol can worsen the effects of any underlying disease condition, including conditions such as dizziness, blurred vision, etc.

It was found that at therapeutic doses of Ticarcillin, no effects on breastfed newborns/infants are anticipated. Ticarcillin can be used during breastfeeding.

Category B

The clinical data on pregnant women, which is more than 1000 pregnancy outcomes, indicates no malformative nor feto/neonatal toxicity of Ticarcillin. Ticarcillin can be used in pregnancy if clinically needed.

A reduced sodium diet has been recommended in the patients being treated with Ticarcillin.

The adverse reactions related to Ticarcillin can be categorized as follows:

• Pain at the injection site and phlebitis
• Hypokalaemia
• Hypernatraemia
• Dose-dependent coagulation defect
• Purpura and hemorrhage
• Hypersensitivity reactions
• Hemolytic anemia
• Interstitial nephritis
• Neutropenia
• CNS toxicity, including convulsions
• Diarrhea
• Pseudomembranous colitis
• Hemorrhagic cystitis, especially in cystic fibrosis patients
• Anaphylaxis.

The clinically relevant drug interactions of Ticarcillin are briefly summarized here:

• Simultaneous administration of the drug probenecid reduces the excretion of penicillins and hence increases the blood level of the antibiotic.
• The bactericidal effect of penicillins can be hindered by concurrent administration of products with bacteriostatic effects, for instance, erythromycin and tetracyclines.

The following are the side effects involving Ticarcillin :

Pregnancy

Category B

The clinical data on pregnant women, which is more than 1000 pregnancy outcomes, indicates that there is no malformation nor feto/neonatal toxicity of Ticarcillin. Ticarcillin can be used in pregnancy if clinically needed.

Lactation

It was found that at therapeutic doses of Ticarcillin, no effects on breastfed newborns/infants are anticipated. Ticarcillin can be used during breastfeeding. Although it is advised that caution be exercised when administering Ticarcillin to patients who are breastfeeding, penicillin are considered compatible with breastfeeding when used in the usual recommended doses.

Physicians should be knowledgeable as well as vigilant about the treatment and identification of overdosage of Ticarcillin.

There is no experience of over dosage with Ticarcillin (Ticarcillin hydrochloride) tablets. However, excessive doses of Ticarcillin are likely to induce nausea, vomiting, abdominal pain, and diarrhea.

Pharmacodynamics

Ticarcillin is said to be a penicillin beta-lactam antibiotic used in the treatment of the bacterial infections caused by susceptible, usually gram-positive, organisms. Ticarcillin has in vitro activity against gram-positive and gram-negative aerobic and anaerobic bacteria. The bactericidal activity of Ticarcillin results from the inhibition of cell wall synthesis as well as is mediated through Ticarcillin binding to penicillin-binding proteins (PBPs).

Pharmacokinetics

• Absorption: Not absorbed from the GI tract. Peak plasma concentrations: 0.5-1 hr (IM).

• Distribution: Widely distributed. Protein-binding: 50%. Plasma half-life: 70 min; 50 min (patients with cystic fibrosis).

• Metabolism: Limited metabolism.

• Excretion: 90% excreted unchanged in the urine.

• https://www.mims.com/philippines/drug/info/ticarcillin?mtype=generic
• https://go.drugbank.com/drugs/DB01607
• https://www.ncbi.nlm.nih.gov/books/NBK548046/
• https://www.sciencedirect.com/topics/medicine-and-dentistry/ticarcillin
• https://www.drugs.com/mtm/ticarcillin.html
• https://pubchem.ncbi.nlm.nih.gov/compound/Ticarcillin
• https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/050658s023,050590s058,050590s059lbl.pdf