Temocillin: Difference between revisions - Wikipedia

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{{Short description|Chemical compound}}

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Temocillin is a β-lactamase-resistant penicillin. It is not active against [[Gram-positive]] bacteria or bacteria with altered [[penicillin-binding protein]]s.{{cn|date=March 2023}}

It is normally active against ''[[Moraxella catarrhalis]]'', ''[[Brucella abortus]]'', ''[[Burkholderia cepacia]]'', ''[[Citrobacter]]'' species, ''[[Escherichia coli]]'', ''[[Haemophilus influenzae]]'', ''[[Klebsiella pneumoniae]]'', ''[[Pasteurella multocida]]'', ''[[Proteus mirabilis]]'', ''[[Salmonella typhimurium]]'', and ''[[Yersinia enterocolitica]]''. It is also active against some ''[[Enterobacter]]'' species, ''[[Morganella morganii]]'', and ''[[Serratia]]'' species. Temocillin has no useful activity against ''[[Acinetobacter]]'' species or ''[[Pseudomonas aeruginosa]]''.<ref>{{cite journal | vauthors = Lupia T, De Benedetto I, Stroffolini G, Di Bella S, Mornese Pinna S, Zerbato V, Rizzello B, Bosio R, Shbaklo N, Corcione S, De Rosa FG | display-authors = 6 | title = Temocillin: Applications in Antimicrobial Stewardship as a Potential Carbapenem-Sparing Antibiotic | journal = Antibiotics | volume = 11 | issue = 4 | pages = 493 | date = April 2022 | pmid = 35453244 | pmc = 9032032 | doi = 10.3390/antibiotics11040493 | doi-access = free }}</ref>

Its primary use is against [[Enterobacteriaceae]], and in particular against strains producing [[extended spectrum beta-lactamase|extended-spectrum β-lactamase]] or [[beta-lactamase#AmpC-type β-lactamases (class C)|AmpC β-lactamase]].<ref name="pmid16531428">{{cite journal | vauthors = Livermore DM, Hope R, Fagan EJ, Warner M, Woodford N, Potz N | title = Activity of temocillin against prevalent ESBL- and AmpC-producing Enterobacteriaceae from south-east England | journal = The Journal of Antimicrobial Chemotherapy | volume = 57 | issue = 5 | pages = 1012–41012–1014 | date = May 2006 | pmid = 16531428 | doi = 10.1093/jac/dkl043 | doi-access = free }}</ref> Temocillin is also usually active against KPC-producing ''K. pneumoniae'', and synergistic activity has been demonstrated when administered alongside fosfomycin.<ref>{{Cite journal | vauthors = Costantino V, Principe L, Mehat J, Busetti M, Piccirilli A, Perilli M, Luzzati R, Zerbato V, Meliadò A, La Ragione R, Di Bella S |date=2024-06-04 |title=Synergistic Activity of Temocillin and Fosfomycin Combination against KPC-Producing Klebsiella pneumoniae Clinical Isolates |journal=Antibiotics |language=en |volume=13 |issue=6 |pages=526 |doi=10.3390/antibiotics13060526 |doi-access=free |issn=2079-6382|pmc=11200827 }}</ref>

==Dosage==

The common dose is 2 g intravenously every 12 hours and the high dose, notably in critically ill patients, is 2g every 8 hours. Theoretical reasons exist for giving temocillin as a continuous intravenous infusion in severe disease<ref name="pmid18070831">{{cite journal | vauthors = De Jongh R, Hens R, Basma V, Mouton JW, Tulkens PM, Carryn S | title = Continuous versus intermittent infusion of temocillin, a directed spectrum penicillin for intensive care patients with nosocomial pneumonia: stability, compatibility, population pharmacokinetic studies and breakpoint selection | journal = The Journal of Antimicrobial Chemotherapy | volume = 61 | issue = 2 | pages = 382–8 | date = February 2008 | pmid = 18070831 | doi = 10.1093/jac/dkm467 | url = | doi-access = free }}</ref><ref name="pmid25433006">{{cite journal | vauthors = Laterre PF, Wittebole X, Van de Velde S, Muller AE, Mouton JW, Carryn S, Tulkens PM, Dugernier T | title = Temocillin (6 g daily) in critically ill patients: continuous infusion versus three times daily administration | journal = The Journal of Antimicrobial Chemotherapy | volume = 70 | issue = 3 | pages = 891–8 | date = March 2015 | pmid = 25433006 | doi = 10.1093/jac/dku465 | url = | doi-access = free }}</ref> a single loading dose of 2 g is given intravenously followed by a 4-g or 6-g infusion over 24 hours. According to the SPC, chemical and physical in-use stability has been demonstrated for 24 hours at 25&nbsp;°C for the following solvents: water for injection, physiological saline (0.9% sodium chloride), dextrose 5%, sodium chloride compound (Ringer's solution), Hartmann solution (sodium lactate compound + Ringer's lactate solution).

Temocillin for intravenous injection is diluted in 10 to 20 ml of sterile water; it is diluted in less than 2 ml of sterile water when being prepared for intramuscular injection; the continuous infusion is diluted in 48 ml of sterile water for ease of administration (2 ml per hour). To reduce pain, the intramuscular injection may be made up using sterile 1% lignocaine instead of sterile water.{{cn|date=March 2023}}