NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Ensuring appropriate use of temocillin

Ensuring appropriate use of TEMOCILLIN – advice for all healthcare professionals

Gram negative resistance to temocillin is increasing and increasing temocillin use has been associated with significant expenditure across all hospital sites in NHSGGC (£600,000 in quarter 1 of 2018). BNF cost for temocillin 2g 12 hourly is £122/day compared to gentamicin at approx £6.60/day. The NHSGGC Antimicrobial Management Team would like to remind prescribers when and how to prescribe.

Temocillin is an IV penicillin with activity against common Gram negative organisms including most ESBL (Extended Spectrum Beta – Lactamase) isolates and has no activity against Gram positive or anaerobic organisms or Pseudomonas. Temocillin was introduced to reduce and preserve piperacillin-tazobactam (Tazocin®) and meropenem and to provide an alternative to gentamicin when eGFR <20ml/min/1.73m2.

From Jan 2019, temocillin will be an Alert/Protected antibiotic in NHSGGC and should only be issued as per indications below. A protected antibiotic form should be completed and sent to pharmacy for all prescriptions.

Indications for Temocillin Use

1. Gentamicin alternative in empirical therapy if:
a. eGFR is <20 ml/min/1.73mor
b. if decompensated cirrhosis or myasthenia gravis


2. Empirical therapy for spontaneous bacterial peritonitis (with amoxicillin)

NOTE: Any patient initiated on IV temocillin should be assessed on a daily basis for IVOST. Please refer to NHSGGC IVOST policy (on StaffNet) to ensure an appropriate and timely switch to oral therapy.

3. In patients NOT SUITABLE FOR IVOST* following 4 days of gentamicin in suspected or proven Gram negative infection click on flowchart here.

 

How to prescribe temocillin in renal impairment

eGFR ml/min/1.73m2   Dose
>30 2g 12 hourly
10-30 2g 24 hourly
<10 2g 48 hourly

 

Oral therapy following temocillin:

  • If eating and drinking and showing signs of clinical improvement (e.g. afebrile, improvement in NEWS score) and there is no positive microbiology, refer to NHSGGC IVOST policy (on StaffNet) and switch as per the infection type. 
  • If the patient has already received 7 days total of IV antibiotics (and no source control required) antibiotics can stop.


If IV Temocillin prescribed out with guidelines above:

  • Consider switching to oral antibiotics as per NHSGGC IVOST policy (on StaffNet) if patient improving and suitable for oral therapy.
  • Switch to gentamicin as per NHSGGC dosing guidelines if IV antibiotics still required and eGFR > 20 ml/min/1.73m2.

Published 19/12/18. Medicines Update blogs are correct at the time of publication.