Dose adjustments▶In neonatesReduce dose if estimated
glomerularfiltration rate less than 60 mL/minute/ 1. 73 m2
.
▶In childrenUse normal dose every 8 hours if estimated
glomerularfiltration rate^30 –^60 mL/minute/^1.^73 m(^2) ;use
half normal dose every 8 hours if estimated glomerular
filtration rate 10 – 30 mL/minute/ 1. 73 m^2 ; use half normal
dose every 12 hours if estimated glomerularfiltration rate
less than 10 mL/minute/ 1. 73 m^2.
lEFFECT ON LABORATORY TESTSFalse-positive urinary
glucose (if tested for reducing substances).
lDIRECTIONS FOR ADMINISTRATIONDisplacement value
may be important, consult local guidelines. For
intermittent infusion, dilute reconstituted solution further
to a concentration of 16 – 32 mg/mL with glucose 5 %;
infuse over 30 – 40 minutes.
lPRESCRIBING AND DISPENSING INFORMATIONDose is
expressed as a combination of ticarcillin (as sodium salt)
and clavulanic acid (as potassium salt) in a ratio of 15 : 1.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder for solution for infusion
ELECTROLYTES:May contain Potassium, sodium
▶Timentin(GlaxoSmithKline UK Ltd)
Clavulanic acid (as Potassium clavulanate) 200 mg, Ticarcillin (as
Ticarcillin sodium) 3 gramTimentin 3. 2 g powder for solution for
infusion vials| 4 vialP£ 21. 32
ANTIBACTERIALS›PENICILLINS, BETA-
LACTAMASE SENSITIVE
eiiiiF 336
Benzylpenicillin sodium
(Penicillin G)
lINDICATIONS AND DOSE
Mild to moderate susceptible infections|Throat infections
|Otitis media|Cellulitis|Pneumonia
▶BY INTRAMUSCULAR INJECTION, OR BY SLOW INTRAVENOUS
INJECTION, OR BY INTRAVENOUS INFUSION
▶Neonate up to 7 days: 25 mg/kg every 12 hours; increased
if necessary to 25 mg/kg every 8 hours, intravenous
route recommended in neonates.
▶Neonate 7 days to 28 days: 25 mg/kg every 8 hours;
increased if necessary to 50 mg/kg every 8 hours in
severe infection, intravenous route recommended in
neonates.
▶Child: 25 mg/kg every 6 hours; increased if necessary to
50 mg/kg every 4 – 6 hours (max. per dose 2. 4 g every
4 hours) in severe infection, intravenous route
recommended in infants
Endocarditis (in combination with other antibacterial if
necessary)
▶BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS
INFUSION
▶Child: 25 mg/kg every 4 hours; increased if necessary to
50 mg/kg every 4 hours (max. per dose 2. 4 g every
4 hours)
Meningitis|Meningococcal disease
▶BY INTRAVENOUS INFUSION
▶Neonate up to 7 days: 50 mg/kg every 12 hours.
▶Neonate 7 days to 28 days: 50 mg/kg every 8 hours.
▶Child: 50 mg/kg every 4 – 6 hours (max. per dose 2. 4 g
every 4 hours)
Suspected meningococcal disease (meningitis with non-
blanching rash or meningococcal septicaemia) prior to
urgent transfer to hospital
▶BY INTRAVENOUS INJECTION, OR BY INTRAMUSCULAR
INJECTION
▶Child 1–11 months: 300 mg, administer as single dose
prior to urgent transfer to hospital so long as does not
delay transfer
▶Child 1–9 years: 600 mg, administer as single dose prior
to urgent transfer to hospital so long as does not delay
transfer
▶Child 10–17 years: 1. 2 g, administer as single dose prior
to urgent transfer to hospital so long as does not delay
transfer
Suspected bacterial meningitis without non-blanching
rash where patient cannot be transferred to hospital
urgently
▶BY INTRAVENOUS INJECTION, OR BY INTRAMUSCULAR
INJECTION
▶Child 1–11 months: 300 mg, administer as single dose
prior to transfer to hospital
▶Child 1–9 years: 600 mg, administer as single dose prior
to transfer to hospital
▶Child 10–17 years: 1. 2 g, administer as single dose prior
to transfer to hospital
Neonatal sepsis
▶BY INTRAMUSCULAR INJECTION, OR BY SLOW INTRAVENOUS
INJECTION, OR BY INTRAVENOUS INFUSION
▶Neonate up to 7 days: 25 mg/kg every 12 hours; increased
if necessary to 25 mg/kg every 8 hours, intravenous
route recommended in neonates.
▶Neonate 7 days to 28 days: 25 mg/kg every 8 hours;
increased if necessary to 50 mg/kg every 8 hours in
severe infection, intravenous route recommended in
neonates.
IMPORTANT SAFETY INFORMATION
Intrathecal injection of benzylpenicillin isnot
recommended.lCAUTIONSAccumulation of sodium from injection can
occur with high doses
lINTERACTIONS→Appendix 1 : penicillins
lSIDE-EFFECTS
▶Common or very commonFever.Jarisch-Herxheimer
reaction
▶Rare or very rareNeurotoxicity
▶Frequency not knownComa
lPREGNANCYNot known to be harmful.
lBREAST FEEDINGTrace amounts in milk, but appropriate
to use.
lRENAL IMPAIRMENTAccumulation of sodium from
injection can occur in renal failure. High doses may cause
neurotoxicity, including cerebral irritation, convulsions, or
coma.
Dose adjustmentsEstimated glomerularfiltration rate
10 – 50 mL/minute/ 1. 73 m^2 , use normal dose every
8 – 12 hours.
Estimated glomerularfiltration rate less than
10 mL/minute/ 1. 73 m^2 use normal dose every 12 hours.
lEFFECT ON LABORATORY TESTSFalse-positive urinary
glucose (if tested for reducing substances).
lDIRECTIONS FOR ADMINISTRATIONIntravenous route
recommended in neonates and infants. Forintravenous
infusion, dilute with Glucose 5 %orSodium Chloride 0. 9 %;
give over 15 – 30 minutes. Longer administration time is
particularly important when using doses of 50 mg/kg (or
greater) to avoid CNS toxicity.338 Bacterial infection BNFC 2018 – 2019
Infection5