Ticarcillin-Clavulanate is a fixed-dose, injectable combination of a broad-spectrum penicillin antibiotic (Ticarcillin) and a beta-lactamase inhibitor (Clavulanic Acid). Ticarcillin is a carboxypenicillin with activity against Gram-negative bacteria, including Pseudomonas aeruginosa. Clavulanic acid irreversibly inhibits many beta-lactamase enzymes, thereby protecting Ticarcillin from degradation and extending its spectrum to include many beta-lactamase-producing strains of bacteria. This combination is primarily used for serious systemic infections in hospitalized patients.
Adult: 3.1 g (Ticarcillin 3000 mg + Clavulanic Acid 100 mg) IV every 4 to 6 hours. For serious systemic infections, including Pseudomonas, every 4 hours is standard. For urinary tract infections, every 6-8 hours may suffice.
Note: For IV use only. Reconstitute vial with 13 mL of Sterile Water for Injection or NaCl 0.9% to yield approx. 15 mL (200 mg/mL of Ticarcillin). Further dilute in a compatible IV solution (e.g., 50-100 mL of NaCl 0.9% or D5W) and infuse over 30 minutes. IM route is possible but painful and not recommended for the 3.1g strength.
Ticarcillin binds to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall. This binding inhibits the final transpeptidation step of peptidoglycan synthesis in the bacterial cell wall, leading to the activation of autolytic enzymes and cell lysis. Clavulanic acid has weak intrinsic antibacterial activity but is a potent, irreversible inhibitor of many bacterial beta-lactamase enzymes (including those produced by Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis, and many Enterobacterales). It binds to and inactivates these enzymes, thereby protecting Ticarcillin from hydrolysis and extending its spectrum.
Pregnancy: Pregnancy Category B (US FDA). Animal studies show no risk, but no adequate, well-controlled studies in pregnant women. Use only if clearly needed. Penicillins cross the placenta and are generally considered safe for use in pregnancy.
Driving: Unlikely to affect ability to drive or operate machinery. However, dizziness has been reported rarely.
| Aminoglycosides (Gentamicin, Amikacin) | Synergistic antibacterial effect against Pseudomonas and other Gram-negatives. PHYSICAL INCOMPATIBILITY: Do not mix in same IV line/syringe as inactivation can occur. Administer separately. | Major |
| Probenecid | Competitively inhibits renal tubular secretion of Ticarcillin, leading to increased and prolonged serum levels. Can be used therapeutically but increases risk of toxicity. | Moderate |
| Methotrexate | Ticarcillin may decrease renal clearance of methotrexate, leading to increased methotrexate levels and severe toxicity (myelosuppression, mucositis). | Major |
| Oral Anticoagulants (Warfarin) | May potentiate anticoagulant effect and increase INR, increasing bleeding risk. Mechanism: Altered gut flora affecting vitamin K synthesis, possible platelet dysfunction. | Major |
| Vecuronium, other neuromuscular blocking agents | May prolong neuromuscular blockade. | Moderate |
| Oral Contraceptives | Possible reduced efficacy due to altered enterohepatic circulation. Advise use of alternative non-hormonal contraception. | Moderate |
Same composition (Ticarcillin (3000mg) + Clavulanic Acid (100mg)), different brands: