High dose intermittent ticarcillin–clavulanate administration in pediatric cystic fibrosis patients

BackgroundThe Intermountain Cystic Fibrosis Pediatric Center utilizes ticarcillin–clavulanate 400 mg/kg/day divided every 6 h, (maximum 24 g/day). This dosing strategy is higher than the Cystic Fibrosis Foundation (CFF) recommendations and the Food and Drug Administration (FDA) approved package labeling. The purpose is to determine the safety of this dosing regimen.MethodsA retrospective study of pediatric cystic fibrosis (CF) patients admitted from January 1, 2005 to December 31, 2009 who received the dosing regimen for at least 7 days. Baseline and follow-up laboratory parameters were recorded. Statistical analysis was performed.Results127 patients met inclusion criteria. The mean (± SD) ticarcillin dose was 3.5 g (± 2.16) every 6 h; while the mean (± SD) total ticarcillin dose was 13.5 g (± 6.5) per day. No significant differences occurred in liver function tests, white blood count, and platelet count from baseline. Serum creatinine showed a statistically significant decrease from baseline.ConclusionsHigher than FDA approved doses of ticarcillin–clavulanate may be safely used in the treatment of exacerbations in pediatric cystic fibrosis patients.