Extended Spectrum Penicillin

Aka: Extended Spectrum Penicillin, Fourth Generation 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. Medications

  1. Alpha carboxy Penicillin
    1. Carbenicillin
      1. Discontinued in U.S. as of 2008
    2. Ticarcillin (Ticar)
      1. Withdrawn from U.S. market as of 2015
    3. Ticarcillin clavulanate (Timentin)
      1. Withdrawn from U.S. market as of 2015
  2. Acylamino-Penicillin
    1. Mezlocillin (Mezlin)
      1. Discontinued in U.S.
    2. Piperacillin (Pipracil)
      1. Not typically used without tazobactam
    3. Piperacillin Tazobactam (Zosyn)
      1. Only Extended Spectrum Penicillin still available in the United States as of 2023
  3. Other structures
    1. Pivmecillinam (Selexid, Pivya)
      1. FDA approved in 2024 for simple cystitis in women

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. Piperacillin Tazobactam (Zosyn)
    1. Adult: 3.375 g IV q6 hours
  2. Ticarcillin Clavulanate (Timentin, not available in U.S.)
    1. Listed for historical purposes, and for use outside the U.S.
    2. Adult: 3.1 g IV q4-6h
    3. Child: 50 mg/kg up to 3.1 g IV q4-6 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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Related Studies

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