TICARCILLIN

Fetal Risk Summary

Ticarcillin is a penicillin antibiotic. Reproduction studies in mice and rats have revealed no evidence of impaired fertility or fetal harm (1).

Ticarcillin rapidly crosses the placenta to the fetal circulation and amniotic fluid (2). Following a 1-g IV dose, single determinations of the amniotic fluid from six patients, 15–76 minutes after injection, yielded levels ranging from 1.0 to 3.3 µg/mL. Similar measurements of ticarcillin in cord serum ranged from 12.6 to 19.2 µg/mL. In a study using in vitro perfused human placentas, the fetal:maternal ratio of ticarcillin was 0.91 (3).

No reports linking the use of ticarcillin with congenital defects have been located. The Collaborative Perinatal Project monitored 50,282 mother-child pairs, 3,546 of whom had 1st-trimester exposure to penicillin derivatives (4, pp. 297–313). For use anytime during pregnancy, 7,171 exposures were recorded (4, p. 435). In neither group was evidence found to suggest a relationship to large categories of major or minor malformations or to individual defects.

Breast Feeding Summary

Ticarcillin is excreted into breast milk in low concentrations. After a 1-g IV dose given to five patients, only trace amounts of drug were measured at intervals up to 6 hours (2). Although these amounts are probably not significant, three potential problems exist for the nursing infant: modification of bowel flora, direct effects on the infant (e.g., allergic response), and interference with the interpretation of culture results if a fever workup is required. The American Academy of Pediatrics considers ticarcillin to be compatible with breast feeding (5).

References

1. Product information. Ticar. SmithKline Beecham Pharmaceuticals, 2000.
2. Cho N, Nakayama T, Vehara K, Kunii K. Laboratory and clinical evaluation of ticarcillin in the field of obstetrics and gynecology. Chemotherapy (Tokyo) 1977;25:2911–23.
3. Fortunato SJ, Bawdon RE, Swan KF, Bryant EC, Sobhi S. Transfer of Timentin (ticarcillin and clavulanic acid) across the in vitro perfused human placenta: comparison with other agents. Am J Obstet Gynecol 1992;167:1595–9.
4. Heinonen OP, Slone, D, Shapiro S. Birth Defects and Drugs in Pregnancy. Littleton, MA: Publishing Sciences Group, 1977.
5. Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:137–50.