What is the dosage and treatment regimen for ticarcillin (Ticar) and clavulanic acid (Augmentin) for bacterial infections?

Ticarcillin-Clavulanate Dosing and Treatment Regimen

For bacterial infections requiring ticarcillin-clavulanate, administer 3.1 g intravenously every 6 hours for complicated intra-abdominal infections, skin and soft tissue infections, and necrotizing fasciitis. 1

Standard Dosing Regimen

• Dose: 3.1 g (ticarcillin 3.0 g + clavulanic acid 0.1 g) IV every 6 hours 1
• Route: Intravenous infusion 2
• Alternative dosing (per FDA labeling):
  • Moderate infections: 200 mg/kg/day divided every 6 hours 1
  • Severe infections: 300 mg/kg/day divided every 4 hours 1

Clinical Indications

Complicated Intra-Abdominal Infections

Ticarcillin-clavulanate is recommended as single-agent therapy for mild-to-moderate community-acquired intra-abdominal infections (e.g., perforated appendicitis, diverticulitis). 1

• Provides coverage against enteric gram-negative bacilli, gram-positive streptococci, and obligate anaerobes including Bacteroides fragilis 1
• Listed as acceptable monotherapy for pediatric complicated intra-abdominal infections 1
• Not recommended for severe infections or high-risk patients, where carbapenems or piperacillin-tazobactam are preferred 1

Skin and Soft Tissue Infections

For necrotizing fasciitis and surgical site infections involving the intestinal or genitourinary tract, ticarcillin-clavulanate 3.1 g every 6 hours IV is an acceptable single-drug regimen. 1

• Effective for polymicrobial infections with mixed aerobic-anaerobic flora 1
• Clinical cure rates of 91% (30/33 patients) demonstrated in soft tissue infections 2
• Comparable efficacy to moxalactam and cefazolin in controlled trials 2, 3

Nosocomial and Polymicrobial Infections

• Demonstrated efficacy in severe nosocomial infections, though combination with aminoglycosides is recommended until organism identification 4
• Response rate of 75% in cancer patients with documented infections 5

Duration of Therapy

• Continue until resolution of clinical signs of infection, including normalization of temperature and white blood cell count 1
• Average treatment duration in clinical trials: 7.7 to 12.5 days 2, 3, 5
• For mild-to-moderate infections without source control procedures, consider early transition to oral therapy 1

Important Caveats

Resistance Considerations

Ticarcillin-clavulanate is being phased out in favor of piperacillin-tazobactam, which offers superior gram-negative coverage and is more frequently recommended in current guidelines. 1

• The WHO Expert Committee excluded ticarcillin-clavulanate from essential medicines recommendations, preferring piperacillin-tazobactam 1
• Increasing resistance among E. coli and Bacteroides fragilis group organisms limits its utility 1

When NOT to Use

• Do not use for severe/high-risk community-acquired infections where broader anti-pseudomonal coverage is needed 1
• Avoid in healthcare-associated infections in critically ill patients; use carbapenems or piperacillin-tazobactam instead 1
• Not appropriate for MRSA coverage; add vancomycin if MRSA is suspected 1

Monitoring

• Obtain cultures before initiating therapy, particularly in higher-risk patients with prior antibiotic exposure 1
• Monitor for clinical response within 48-72 hours 1
• Adjust therapy based on culture results if resistant organisms are identified 1

Pediatric Dosing

For children with complicated intra-abdominal infections, ticarcillin-clavulanate is acceptable as part of broad-spectrum coverage, though specific pediatric dosing should be weight-based following FDA guidelines (200-300 mg/kg/day divided). 1