Extended Spectrum Penicillin

Aka: Extended Spectrum Penicillin, Ticarcillin, Piperacillin, Carbenicillin, Timentin

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II. Indications

  1. Serious Gram Negative Bacterial infection
  2. Use alone or in combination with Aminoglycosides

III. Preparations

  1. Alpha carboxy Penicillin
    1. Carbenicillin
    2. Ticarcillin (Ticar)
    3. Ticarcillin clavulanate (Timentin)
  2. Acylamino-Penicillin
    1. Mezlocillin (Mezlin)
    2. Piperacillin (Pipracil)
    3. Piperacillin tazobactam (Zosyn)

IV. Mechanism

  1. Similar to Natural Penicillins
  2. Greater penetration through Gram Negative membrane
  3. High affinity for Penicillin binding Proteins
  4. Beta lactamase resistance with Clavulanate, Tazobactam

V. Mechanism: Bacterial Resistance

  1. Beta lactamase (except with Clavulanate or Tazobactam)
  2. Alteration of Penicillin binding Proteins (Pseudomonas)

VI. Dosing: Parenteral

  1. Ticarcillin Clavulanate (Timentin)
    1. Adult: 3.1 g IV q4-6h
    2. Child: 50 mg/kg up to 3.1 g IV q4-6 hours
  2. Piperacillin Tazobactam (Zosyn)
    1. Adult: 3.375 g IV q6 hours

VII. Adverse Effects

  1. Many side effects in addition to Natural Penicillins
  2. High Sodium load (Carbenicillin)
  3. Platelet Dysfunction

VIII. Activity Spectrum

  1. Similar to Natural Penicillins and Aminopenicillins
  2. Expanded Gram Negative coverage
    1. Escherichia coli
    2. Morganella
    3. Proteus
    4. Providencia
    5. Salmonella
    6. Shigella
    7. Pseudomonas

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