Antibacterial drugs

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.

The drug also has been used for the treatment of anaerobic or mixed aerobic-anaerobic bacterial infections or for empiric anti-infective therapy in febrile granulocytopenic patients. For specific information on the uses of ticarcillin, seeUses in the Extended-Spectrum Penicillins General Statement 8:12.16.16. For information on the uses of ticarcillin in a fixed-ratio combination with clavulanic acid. Ticarcillin disodium is administered by slow IV injection or infusion or by deep IM injection.

Piperacillin sodium and tazobactam sodium is used parenterally for the treatment of moderate to severe infections caused by, or suspected of being caused by, susceptible b-lactamase-producing bacteria when piperacillin alone would be ineffective.

Dosage of piperacillin sodium and tazobactam sodium is expressed in terms of the total of the piperacillin and tazobactam content of the fixed combination. Potency of both piperacillin sodium and tazobactam sodium are expressed in terms of the bases of the drugs.

Oral carbenicillin indanyl sodium has been used with some success for short-term therapy or long-term suppressive therapy in the treatment of acute or chronic infections of the upper and lower urinary tract or for asymptomatic bacteriuria caused by susceptible strains of enterococci, Enterobacter, Escherichia coli, Morganella morganii, Proteus mirabilis, P. vulgaris, P. rettgeri, or Pseudomonas aeruginosa. However, most clinicians state that the drug is not a drug of choice for these infections. Some clinicians suggest that uncomplicated urinary tract infections should be treated with co-trimoxazole, fluoroquinolones, oral cephalosporins, nitrofurantoin, or fosfomycin; complicated urinary tract infections generally require parenteral therapy.

Amikacin, gentamicin, kanamycin, or tobramycin is used IM or IV in the short-term treatment of serious infections such as septicemia (including neonatal sepsis), bone and joint infections, skin and soft tissue infections (including those resulting from burns), respiratory tract infections, and postoperative and intra-abdominal infections (including peritonitis) caused by susceptible strains of gram-negative bacteria.

Oral carbenicillin indanyl sodium is used only for the treatment of acute or chronic infections of the upper and lower urinary tract, asymptomatic bacteriuria, or prostatitis caused by susceptible organisms.

Oxacillin shares the uses of other parenteral penicillinase-resistant penicillins (e.g., nafcillin) and generally is used only in the treatment of infections caused by, or suspected of being caused by, susceptible penicillinase-producing staphylococci. For specific information on the uses of oxacillin, see Uses in the Penicillinase-Resistant Penicillins General Statement 8:12.16.12. Oxacillin sodium is administered by IM injection or slow IV injection or infusion. Although oxacillin has been administered orally, an oral preparation of the drug is no longer commercially available in the US.

Dicloxacillin shares the uses of other penicillinase-resistant penicillins and generally is used only in the treatment of infections caused by, or suspected of being caused by, susceptible penicillinase-resistant staphylococci. Oral dicloxacillin should not be used for the initial treatment of severe, life-threatening infections, including endocarditis, but may be used as follow-up after therapy with a parenteral penicillinase-resistant penicillin (e.g., nafcillin, oxacillin). For specific information on the uses of dicloxacillin, see Uses in the Penicillinase-Resistant Penicillins General Statement 8:12.16.12.

Penicillinase-resistant penicillins are used in the treatment of infections caused by, or suspected of being caused by, susceptible penicillinase-producing staphylococci. Although penicillinase-resistant penicillins have been effective when used in the treatment of infections caused by other susceptible gram-positive aerobic cocci (e.g., Streptococcus pneumoniae, S. pyogenes, nonpenicillinase-producing staphylococci), the drugs are less active than natural penicillins against these gram-positive bacteria in vitro on a weight basis and should not be used in the treatment of infections caused by organisms susceptible to penicillin G and penicillin V.