Ticarcillin disodium and clavulanate potassium is used for the treatment of lower respiratory tract infections, skin and skin structure infections, complicated and uncomplicated urinary tract infections, bone and joint infections, septicemia, intra-abdominal infections (e.g., peritonitis), and gynecologic infections (e.g., endometritis), caused by susceptible organisms.
Ticarcillin disodium and clavulanate potassium is used principally for the treatment of infections caused by, or suspected of being caused by, susceptible b-lactamase-producing strains of Citrobacter, Enterobacter, Escherichia coli, Haemophilus influenzae, Klebsiella, Pseudomonas, Serratia, and Staphylococcus when an extended-spectrum penicillin alone would be ineffective.
Although ticarcillin disodium and clavulanate potassium also may be effective in the treatment of infections caused by non-b-lactamase-producing organisms susceptible to ticarcillin alone, some clinicians suggest that ticarcillin disodium and clavulanate potassium be reserved for use in the treatment of infections caused by, or suspected of being caused by, b-lactamase-producing organisms when an extended-spectrum penicillin alone would be ineffective. The drug may be particularly useful for the empiric treatment of nosocomial urinary or respiratory tract infections or intra-abdominal or pelvic infections likely to involve anaerobes (e.g., mixed aerobic-anaerobic infections), or for infections suspected to be caused by both ticarcillin-resistant and ticarcillin-susceptible organisms (e.g., peritonitis).
Prior to initiation of therapy with ticarcillin disodium and clavulanate potassium, appropriate specimens should be obtained for identification of the causative organism and in vitro susceptibility tests. Ticarcillin disodium and clavulanate potassium therapy may be started pending results of susceptibility tests if the infection is believed to be caused by b-lactamase-producing bacteria susceptible to the drug, but should be discontinued if the organism is found to be resistant to the drug.
Gram-positive Aerobic Bacterial Infections
Ticarcillin disodium and clavulanate potassium has been effective when used in adults for the treatment of pneumonia, osteomyelitis, skin and skin structure infections, pericarditis, septicemia, and gynecologic infections (e.g., endometritis) caused by susceptible penicillinase-producing or nonpenicillinase-producing S. aureus or S. epidermidis; S. pneumoniae; group A b-hemolytic streptococci; enterococci; or Corynebacterium. However, natural penicillins generally are the drugs of choice for the treatment of infections caused by nonpenicillinase-producing staphylococci or group A b-hemolytic streptococci, and penicillinase-resistant penicillins generally are the drugs of choice for the treatment of infections caused by susceptible penicillinase-producing staphylococci. Ticarcillin and clavulanate potassium should not be used in the treatment of infections caused by oxacillin-resistant staphylococci (previously known as methicillin-resistant staphylococci), even though results of in vitro susceptibility tests may indicate that the organism is susceptible to the drug.
Gram-negative Aerobic Bacterial Infections
Ticarcillin disodium and clavulanate potassium has been effective when used in adults for the treatment of lower respiratory tract infections caused by susceptible H. influenzae, H. parainfluenzae, or Klebsiella; uncomplicated or complicated urinary tract infections caused by susceptible Citrobacter, Enterobacter cloacae, E. coli, K. pneumoniae, or Serratia; skin or skin structure infections caused by susceptible E. coli or Klebsiella; septicemia caused by susceptible E. coli, Klebsiella, or Serratia; intra-abdominal infections (e.g., peritonitis) caused by susceptible E. coli or K. pneumoniae; and gynecologic infections (e.g., endometritis) caused by susceptible Enterobacter (including Enterobacter cloacae), E. coli, or K. pneumoniae.
Ticarcillin disodium and clavulanate potassium has been effective in some cases when used alone or in conjunction with an aminoglycoside in the treatment of infections caused by susceptible Ps. aeruginosa. However, in vitro studies indicate that concomitant use of clavulanic acid with ticarcillin generally results in little or no synergism against Ps. aeruginosa, and some clinicians suggest that further study is needed to evaluate efficacy of ticarcillin disodium and clavulanate potassium in the treatment of severe infections caused by Pseudomonas.
Anaerobic and Mixed Aerobic-Anaerobic Infections
Ticarcillin disodium and clavulanate potassium is used for the treatment of gynecologic infections (e.g., endometritis) caused by susceptible Bacteroides (including B. melaninogenicus). The drug also has been effective when used alone in a limited number of patients for the treatment of mixed aerobic-anaerobic bacterial infections such as intra-abdominal infections and gynecologic infections (including endometritis). For the treatment of intra-abdominal infections that are likely to involve anaerobes, most clinicians consider the combination of an aminoglycoside (e.g., gentamicin) and either metronidazole or clindamycin the initial therapy of choice and ticarcillin disodium and clavulanate potassium alone an alternative regimen.
Other alternative regimens include ampicillin sodium and sulbactam sodium, imipenem and cilastatin sodium, cefoxitin, or cefotetan, each used alone. Clinical studies generally do not show any substantial differences in efficacy among these regimens. For severely ill patients, some clinicians suggest the addition of an aminoglycoside to most of the alternative regimens. Ticarcillin and clavulanate potassium may be particularly useful as a single agent for the treatment of community-acquired infections of mild to moderate severity, such as appendicitis or diverticulitis, or infections from penetrating trauma.
Abscesses or other highly localized infections usually involve surgical intervention. In addition to comparative efficacy, factors such as toxicity, simplicity of dosing, and cost contribute to decisions regarding antimicrobial therapy. For the treatment of intra-abdominal infection in geriatric and other patients, ticarcillin and clavulanate potassium may be an alternative to combination therapy with agents associated with greater risk of adverse effects, such as aminoglycosides.