Temocillin: Difference between revisions

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| image = Temocillin.png

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| InChI = 1/C16H18N2O7S2/c1-15(2)9(12(22)23)18-13(24)16(25-3,14(18)27-15)17-10(19)8(11(20)21)7-4-5-26-6-7/h4-6,8-9,14H,1-3H3,(H,17,19)(H,20,21)(H,22,23)/t8?,9-,14+,16-/m0/s1

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'''Temocillin''' is a [[beta-lactamase|β-lactamase]] resistant [[penicillin]]<ref name="pmid17550891">{{cite journal |author=Andrews JM, Jevons G, Walker R, Ashby J, Fraise AP |title=Temocillin susceptibility by BSAC methodology |journal=J. Antimicrob. Chemother. |volume=60 |issue=1 |pages=185–7 |year=2007 |month=July |pmid=17550891 |doi=10.1093/jac/dkm179 |url=http://jac.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17550891}}</ref><ref name="pmid7181470">{{cite journal |author=Van Landuyt HW, Pyckavet M, Lambert A, Boelaert J |title=In vitro activity of temocillin (BRL 17421), a novel beta-lactam antibiotic |journal=Antimicrob. Agents Chemother. |volume=22 |issue=4 |pages=535–40 |year=1982 |month=October |pmid=7181470 |pmc=183789 |doi= |url=http://aac.asm.org/cgi/pmidlookup?view=long&pmid=7181470}}</ref> introduced by [[Beecham (pharmaceutical company)|Beecham]], marketed by [[Eumedica Pharmaceuticals]] as Negaban primarily for the treatment of multiresistant [[Gram negative]] bacteria.

It is a [[carboxypenicillin]].<ref name="pmid6348653">{{cite journal |author=Chanal M, Sirot J, Cluzel M, Joly B, Glanddier Y |title=[In vitro study of the bacteriostatic and bactericidal activity of temocillin (BRL 17421)] |language=French |journal=Pathol. Biol. |volume=31 |issue=6 |pages=467–70 |year=1983 |month=June |pmid=6348653 |doi= |url=}}</ref>

Temocillin is a [[beta-lactamase|β-lactamase]] resistant [[penicillin]]. It is not active against [[Gram positive]] bacteria or bacteria with altered [[penicillin-binding protein]]s.

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 [[Gram positive]] organisms, ''[[Acinetobacter]]'' species, or ''[[Pseudomonas aeruginosa]]''.

Its primary use is against [[Enterobacteriaceae]], and in particular against strains producing [[extended spectrum beta-lactamase|extended spectrum β-lactamase]] or [[AmpC]] [[beta-lactamase|β-lactamase]].<ref>Livermore DM ''et al.'' (2006) Activity of temocillin vs. prevalent ESBL- and AmpC-producing Enterobacteriaceae from SE England. J Antimicrob Chemother. 2006 May;57(5):1012-4.</ref>

The common dosage is 2g intravenously every 12 hours. There are good theoretical reasons for giving Temocillin as a continuous intravenous infusion in severe disease:<ref>De Jongh R ''et al.'' (2008) 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. J Antimicrob Chemother. 2008 Feb;61(2):382-8.</ref> a single loading dose of 2g is given intravenously followed by a 4g infusion over 24 hours. Temocillin for intravenous injection is diluted in 20ml of sterile water; it is diluted in less than 2.7ml of sterile water when being prepared for intramuscular injection; the continuous infusion is diluted in 48ml of sterile water for ease of administration (1ml per half hour). To reduce pain, the intramuscular injection may be made up using sterile 1% lignocaine instead of sterile water.

Temocillin may be given to patients with impaired renal function. No adjustment needs to be made to the dose in mild to moderate renal impairment ([[creatinine clearance]] greater than 30ml/min). The manufacturer does not recommend using reduced doses, instead they recommend increasing the duration between doses. In severe renal impairment when it is 10 to 30, the dose is 1g in 24 hours; when less than 10, the dose is 1g every 48 hours. Temocillin is cleared by [[haemodialysis]], which means that in dialysis patients, the dose should be given ''after'' dialysis.

There is no licensed oral preparation of temocillin.

The undesirable effects of temocillin are those of any β-lactam antibiotic. In particular, Temocillin has been associated with angioedema and anaphylaxis in penicillin allergic patients. Animal studies have not shown any induction of ''[[Clostridium difficile]]'' infection.<ref>{{cite journal | author=Boon RJ ''et al.'' | title=Studies with temocillin in a hamster model of antibiotic-associated colitis| journal=Antimicrob Agents Chemother | year=1985 | volume=27 | issue=6 | pages=980–1 | url= | pmid=3875312 | pmc=180203 }}</ref> As with any other penicillin, convulsions can occur if very high doses are given.

==References==

==Further reading==

*{{cite journal |author=Livermore DM, Tulkens PM |title=Temocillin revived |journal=[[Journal of Antimicrobial Chemotherapy]] |volume=63 |issue=2 |pages=243–5 |year=2009 |month=February |pmid=19095679 |doi=10.1093/jac/dkn511}}

[[Category:Beta-lactam antibiotics]]

[[it:Temocillina]]

[[th:เทโมซิลลิน]]