Drug reference

Ticarcillin and Clavulanate

Antipseudomonal penicillin + beta-lactamase inhibitor (fixed combination) · Antibiotic

Also known as Ticarcillin sodium, Potassium clavulanate, Timentin

START

3.1 g IV every 4–6 h

TYPICAL MAX

≈18–24 g ticarcillin/day

STOP IF

Anaphylaxis, C. difficile colitis, or cholestatic hepatitis

WATCH

Renal function, potassium/sodium, coagulation (high dose), LFTs

CDSCO approvedSchedule HATC J01CR03

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 6min · infusion start
PEAK: 30min · end infusion
t½: 1.1h · t½
DURATION: 5h · q4–6h

EXCRETION

Renal — predominantly unchanged

route + CYP

INTERACTIONS

—

none in our sources

PREGNANCY

Generally considered acceptable when indicated (penicillin class).

FDA category + note

Mechanism

Ticarcillin (carboxypenicillin) inhibits bacterial cell-wall synthesis via penicillin-binding proteins; clavulanate irreversibly inhibits many beta-lactamases, restoring activity against beta-lactamase-producing organisms including Pseudomonas and anaerobes.

Indications

SepticaemiaLower respiratory tract infectionsComplicated intra-abdominal/urinary infectionsSkin/soft-tissue and bone/joint infectionsGynaecological infections (mixed/Gram-negative/anaerobic)

Dosing

Adult: 3.1 g (3 g ticarcillin/0.1 g clavulanate) IV every 4–6 h; severe infection up to every 4 h.
Pediatric: ≥3 months: 200–300 mg/kg/day (ticarcillin) IV divided every 4–6 h.
Renal adjustment: Reduce dose/extend interval per CrCl (e.g., 2 g q4–8h; lower in severe/HD).
Hepatic adjustment: Caution; monitor LFTs (clavulanate cholestasis).
Geriatric: Adjust for renal function; sodium load awareness.
Max dose: Ticarcillin ~18–24 g/day (≈3.1 g every 4 h)

Pharmacokinetics

Onset

Bactericidal levels from infusion

Peak effect

End of infusion

Duration

Dose every 4–6 h

Half-life

Ticarcillin ~1.1 h; clavulanate ~1 h (prolonged in renal failure)

Bioavailability

IV 100%

Protein binding

Ticarcillin ~45%; clavulanate ~25%

Metabolism

Minimal

Excretion

Renal (predominantly unchanged)

Contraindications

Penicillin/beta-lactam hypersensitivity
History of clavulanate-associated cholestatic jaundice
Caution: severe renal impairment (dose adjust), sodium load in CHF

Side effects

Common

DiarrhoeaRashNauseaInjection-site reactionsHypokalaemia

Serious

Anaphylaxis
Clostridioides difficile colitis
Bleeding/platelet dysfunction (high dose)
Hypokalaemia/sodium overload
Cholestatic hepatitis
Seizures (very high dose/renal failure)

Pregnancy & lactation

Pregnancy

Generally considered acceptable when indicated (penicillin class).

Lactation

Compatible with breastfeeding (penicillin class).

Drug interactions

Aminoglycosides

Moderate

Database

Physical/chemical inactivation if mixed

Administer separately; do not co-mix