티카실린 / 클라불란산

주사용 광범위 페니실린 + 베타락타마제 억제제Critically Important

티카실린/클라불란산(Timentin®)은 강력한 주사용 **광범위 페니실린**(항녹농균 페니실린)과 **베타락타마제 억제제**의 복합제입니다. * **항균 스펙트럼 확장:** 클라불란산이 추가되어 효소 분해로부터 티카실린을 보호하며, 베타락타마제를 생성하는 *대장균*, *파스퇴렐라*, *포도상구균*, *클레브시엘라*, *프로테우스* 균주에 대한 효능을 확장합니다. * **임상적 핵심:** 수의학에서는 *녹농균*에 대한 효능이 특히 높게 평가되며, 주로 심각한 원내 감염, 패혈증 또는 균혈증에 사용하기 위해 보류됩니다. * **대체 용도:** 주로 전신성 병원 약물로 사용되지만, 반려견의 난치성 *녹농균*성 귀 감염의 보조 치료를 위해 점이액으로 조제되어 사용되기도 합니다.

작용 기전: **Ticarcillin** is a bactericidal beta-lactam antibiotic: * Binds to specific **Penicillin-Binding Proteins (PBPs)** (such as transpeptidases and carboxypeptidases) located inside the bacterial cytoplasmic membrane. * Inhibits bacterial cell wall mucopeptide synthesis → creates an osmotically unstable spheroplast → leads to cell lysis and death. **Clavulanate Potassium** is a "suicide inhibitor": * Competitively and irreversibly binds to **beta-lactamase enzymes** (including types II, III, IV, V, and staphylococcal penicillinases). * Prevents these enzymes from hydrolyzing the beta-lactam ring of ticarcillin, thereby restoring and expanding its antimicrobial spectrum. * *Note:* Type I beta-lactamases (often associated with *E. coli*, *Enterobacter*, and *Pseudomonas*) are generally not inhibited by clavulanic acid.

동물 종별 용량

Cats

Sepsis · 40-50 mg/kg · IV · q6-8h · Dosed on the basis of ticarcillin content
Pseudomonas sepsis/bacteremia · 40 mg/kg · IV · q6h · Dosed on the basis of ticarcillin content
Resistant Pseudomonas infections · 50 mg/kg · IV or IM · 4 times daily · May need more frequent dosing or constant rate infusion for resistant infections
Susceptible infections · 15-50 mg/kg · IV, IM or SC · q6-8h · Dosed on the basis of ticarcillin content
Serious systemic infections · 15-25 mg/kg followed by CRI at 7.5-15 mg/kg/h · IV · CRI · As directed · Initial bolus followed by continuous rate infusion
Pseudomonas otitis (adjunct) · 0.25-0.5 ml of a 100 mg/ml injectable ticarcillin solution · topical · q8h · As directed · Instil into the affected ear

Horses

Susceptible infections · 50 mg/kg · IV · q6h · Dosed on the basis of ticarcillin content
Neonatal septicemia (Foals) · 40-60 mg/kg · IV or IM · q8h · Dosed on the basis of ticarcillin content
Susceptible infections (Foals) · 50 mg/kg · IV or IM · q6-8h · Dosed on the basis of ticarcillin content
Intrauterine infusion · 3-6 grams with a minimum of 200 mL of saline · Intrauterine · every 4-6 h · Mares need to be treated frequently in order to maintain drug concentrations above MIC.

투여 경로

IVIMSCTopical (compounded otic)IntrauterineTopical

금기

Documented hypersensitivity to penicillins or other beta-lactam antibiotics
Known hypersensitivity to penicillins or other beta-lactam antibiotics

이상반응

Hypersensitivity reactions (allergic reactions)
Platelet dysfunction and bleeding (especially at high doses or with renal impairment)
CNS effects including headache, giddiness, hallucinations, and seizures (at high doses)
Pain at intramuscular (IM) injection sites
Phlebitis or local vein irritation (IV administration)
Antibiotic-associated diarrhea or colitis
Nausea
Diarrhoea
Skin rashes

약물 상호작용

Aminoglycosides (e.g., amikacin, gentamicin, tobramycin) · In vitro synergy against certain bacteria; however, penicillins can chemically inactivate aminoglycosides in vitro and in vivo (especially in renal failure or at massive doses). Do not mix in the same syringe or IV line.
Probenecid · Reduces renal tubular secretion of ticarcillin, maintaining higher systemic levels for a longer duration (does not affect clavulanate elimination).
Warfarin · Increased risk of bleeding due to potential ticarcillin-induced platelet dysfunction; use with caution.
Heparin · Increased risk of bleeding due to potential ticarcillin-induced platelet dysfunction; use with caution.
Aminoglycosides (e.g., gentamicin) · Mutual inactivation if mixed in the same syringe. However, there is significant synergism in vivo against Pseudomonas when administered separately. · major

모니터링

Clinical efficacy (resolution of clinical signs, WBC count, fever)
Renal function (in patients with pre-existing impairment)
Signs of bleeding or CNS abnormalities (if on high doses)
Clinical signs of infection resolution
Renal function (in prolonged use)
Signs of hypersensitivity or adverse gastrointestinal effects

과용량

A single inadvertent overdose is unlikely to cause significant morbidity. However, very high dosages of parenteral penicillins (especially in patients with underlying renal disease) have induced **CNS effects** (hallucinations, headaches, seizures) and alterations in **platelet function** leading to bleeding.

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