Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

TICARCILLIN/CLAVULANATE (Timentin ® )Usual DoseAdult: 3.1 g Q4-6H IV (UWHC cost/day $40.70-61.05).Pediatric:** 200-400 mg of ticarcillin component/kg/day IV in divided doses Q4-6H.Indications1. Stenotrophomonas maltophilia, second-line agent for sulfa-allergic patients or for TMP/SMZ-resistant strains.2. Intraabdominal infections caused by healthcare associated organisms.CommentsDose adjustment required for renal impairment. See renal dosing guideline on uconnect.NOTE: Other combination antibiotics base their dose either on one component (e.g. Primaxin ® ) or both components (e.g.trimethoprim/sulfamethoxazole). Timentin ® labeling states the dose (3.1 g) by adding the two components of ticarcillin (3g) plus clavulanate. Ticarcillin is not effective against most strains of S aureus and, unlike piperacillin, is ineffective againstEnterococcus. Ticarcillin may have less toxicity (neutropenia, drug fever or rash) than piperacillin. Ticarcillin has higherMICs than, but equivalent efficacy to, piperacillin. Not recommended for use in pregnancy. Each gram of ticarcillincontains 5.2-6.5 mEq sodium.TIGECYCLINEInfectious Disease approval is required for use of tigecycline (see Appendix I).Usual DoseAdult: Initial dose of 100 mg IV followed by 50 mg Q12H IV (UWHC cost/day $120.31)Indications1. Complicated skin and skin structure infections caused by susceptible strains of Escherichia coli, Enterococcusfaecalis (vancomycin susceptible isolates), methicillin-sensitive Staphylococcus aureus, methicillin-resistant S.aureus, Streptococcus agalactiae, the Streptococcus anginosus group, Streptococcus pyogenes and Bacteroidesfragilis2. Complicated intra-abdominal infections caused by susceptible strains of Citrobacter freundii, Enterobacter cloacae, E.coli, Klebsiella oxytoca, Klebsiella pneumoniae, E. faecalis (vancomycin susceptible isolates), methicillin-susceptibleS. aureus, S. anginosus group, B. fragilis, Bacteroides thetaiotamicron, Bacteroides uniformis, Bacteroides vulgatus,Clostridium perfringens and Peptostreptococcus micros.3. Alternative for community-acquired pneumonia in patients highly allergic to beta lactams and fluoroquinolones.CommentsNausea and vomiting occur frequently with the use of tigecycline. Tigecycline should not ordinarily be used to treatinfections caused solely by gram-positive infections because there are other effective choices for most gram-positiveorganisms, but instead should be reserved for use against resistant gram-negative bacteria, especially in the ICU, or inmixed infections where there are resistant microorganisms.Drug InteractionsTigecycline causes a decrease in the clearance of R-warfarin and S-warfarin and increases the C max of both isomers,although prolongation of INR was not observed. Nevertheless, increased monitoring of anticoagulation times is warrantedwhen the drugs are administered concomitantly.TIMENTIN ® - see ticarcillin/clavulanateTIPRANAVIR (Aptivus®) – Nonformulary at UWHCFor up-to-date information on the use of antiretrovirals, consult an HIV expert or www.aidsinfo.nih.gov/Black Box Warning: Hepatic decompensation and clinical hepatitis, occasionally with fatal outcomes, have beenassociated with the use of tipranavir. Fatal and nonfatal intracranial hemorrhages have been reported with tipranavir.