1: J Antimicrob Chemother. 2009 Feb;63(2):243-5. Epub 2008 Dec 18.

Temocillin revived.

Livermore DM, Tulkens PM.

Antibiotic Resistance Monitoring and Reference Laboratory, Health Protection
Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK.

Resistance in Gram-negative pathogens is an increasing concern, with carbapenems 
often appearing as the only acceptable treatment option in serious infections.
Reviving older compounds that have fallen into disuse may help to alleviate this 
burden. Temocillin (6-alpha-methoxy-ticarcillin) is resistant to most if not all 
classical and extended-spectrum beta-lactamases and to AmpC enzymes. It is also
chemically stable, allowing administration by continuous infusion.
Pharmacokinetic/pharmacodynamic analysis, aided by Monte-Carlo simulations,
suggests a breakpoint of 8 mg/L for the registered maximum dosage of 4 g daily.
Temocillin's weaknesses, explaining its limited previous use, are a lack of
activity against Gram-positive organisms, anaerobes and Pseudomonas. In settings 
where these are unlikely or are covered by other agents, temocillin may be
useful, potentially 'sparing' carbapenems and having little apparent potential to
select for Clostridium difficile.

PMID: 19095679 [PubMed - in process]

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