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Carboxypenicillin (β-lactamase stable) Pregnancy: Use in pregnancy cannot be recommended — animal studies have shown no teratogenic effects but there is no experience of temocillin in human pregnancy. Mothers should not breastfeed their infants while receiving temocillin, as trace quantities of penicillins can be detected in breast milk. No effects on fertility have been observed in animal studies.

Temocillin

Brand names: Negaban

Temocillin is a narrow-spectrum beta-lactam (a derivative of ticarcillin) used for infections caused by susceptible Gram-negative bacteria, including many that produce extended-spectrum and AmpC beta-lactamases.

Adult dose

Dose: Infections caused by susceptible beta-lactamase-producing organisms, adults including the elderly with normal renal function: usual dose 4 g per day, divided into 2 administrations or given as a continuous infusion
Route: Intravenous injection, intermittent or continuous intravenous infusion, or intramuscular injection. Intravenous solutions should be given by slow injection into the vein over 3-4 minutes or as an intravenous infusion over 30-40 minutes. Continuous intravenous infusion may be considered when therapeutic objectives are difficult to reach with intermittent administrations, and a loading dose of 2 g should be administered before starting the continuous infusion. Intramuscularly, Negaban may be given after reconstitution; if pain is experienced at the site of intramuscular injection, a sterile solution of lidocaine hydrochloride 0.5-1% may be used in place of water for injection
Frequency: Twice daily (4 g per day divided into 2 administrations) or by continuous infusion; three times daily when the high dose of 6 g per day is used
Max: 6 g per day — the highest daily dose stated in this SPC's posology, described as the high dose 'notably in critically ill patients', divided into 3 administrations or given as a continuous infusion. There is no higher figure anywhere in the quoted posology. Lower ceilings apply in renal impairment (see renalAdjustment)
Verbatim posology for adults including the elderly with normal renal function: 'Usual dose: 4 g per day to be divided into 2 administrations or as continuous infusion. High dose notably in critically ill patients: 6 g per day to be divided into 3 administrations or as continuous infusion. A loading dose of 2 g should be administered before starting the continuous infusion.' The SPC does not name individual infection types in its posology, so the dose above is stated as the general adult dose rather than being attributed to any single indication. DIALYSIS. Intermittent high-flux haemodialysis: 'As a rule, the I.M. route should be avoided, considering the patient's treatment with heparin. I.V. injection of Negaban is recommended, using water for injection or physiological saline as solvent: 1 g (I.V. injection) per 24 h of inter-dialytic session, preferably at the end of the hemodialysis (1 g q24 h, 2 g q48 h, 3 g q72 h).' Continuous ambulatory peritoneal dialysis: '1 g Negaban I.M. every 24 hours.' HEPATIC IMPAIRMENT: 'Limited experience in patients with impaired hepatic function has not indicated a need for a reduction in dosage.' SODIUM CONTENT: approximately 5 mmol per vial.

Paediatric dose

Route: Not applicable — no paediatric regimen is licensed
Frequency: Not applicable
NO PAEDIATRIC DOSE IS PUBLISHED BECAUSE THE SPC GIVES NONE. Verbatim: 'Children: Insufficient data are available to recommend an appropriate dosage regimen.' dosePerKg is deliberately null — do not derive, scale or interpolate a paediatric figure from the adult dose.

Dose adjustments

Renal

Dose adjustment is necessary in moderate and severe renal failure. By creatinine clearance, dose per administration and interval between administrations: more than 60 ml/min — 2 g every 12 h; 60 to 30 ml/min — 1 g every 12 h; 30 to 10 ml/min — 1 g every 24 h; less than 10 ml/min — 1 g or 500 mg, every 48 h or every 24 h respectively. Intermittent high-flux haemodialysis: 1 g by intravenous injection per 24 h of inter-dialytic session, preferably at the end of the haemodialysis (1 g q24 h, 2 g q48 h, 3 g q72 h); the intramuscular route should as a rule be avoided because of concurrent heparin. Continuous ambulatory peritoneal dialysis: 1 g intramuscularly every 24 hours. These data are based on studies where creatinine clearance was used to estimate the degree of renal impairment.

Hepatic

Limited experience in patients with impaired hepatic function has not indicated a need for a reduction in dosage.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • History of allergic reactions to any of the penicillins or any other type of beta-lactam drug
  • Hypersensitivity to the active substance or to any of the excipients

Side effects

  • Diarrhoea
  • Pain at the site of intramuscular injection
  • Rash, either urticarial or erythematous (occasional)
  • Fever, arthralgia or myalgia, sometimes developing more than 48 hours after the start of treatment
  • Angioedema and anaphylaxis, as with other beta-lactam antibiotics
  • Phlebitis and thrombophlebitis with intravenous administration, although to a lesser extent than with other beta-lactams
  • Neurological disorders with convulsions following intravenous injection of high doses, reported in patients with renal failure
  • Bleeding manifestations, sometimes with abnormal coagulation tests, more likely in renal failure
  • Pseudomembranous colitis
  • Modest elevations of indices of liver function

Interactions

  • The SPC section on interaction with other medicinal products states: 'None known.'

Monitoring

  • Renal function — posology must be adapted to the degree of renal insufficiency
  • Signs of bleeding and coagulation abnormalities; discontinue the antibiotic and institute appropriate therapy if bleeding manifestations occur
  • Severe or persistent diarrhoea — discontinue and start suitable therapy (for example oral metronidazole or oral vancomycin); antiperistaltic preparations are contraindicated
  • Periodic electrolyte determinations in patients with low potassium reserves, and awareness of hypokalaemia in patients receiving cytotoxic therapy or diuretics
  • Microbiological follow-up may be required to detect superinfection with resistant organisms, particularly during prolonged treatment
  • Neuromuscular excitability or convulsions if higher than recommended doses are given intravenously

Clinical monograph

How it works

It inhibits bacterial cell-wall synthesis by binding penicillin-binding proteins, and its stability to many beta-lactamases underlies its activity against resistant Enterobacterales.

Prescribing in practice

  • It is contraindicated in patients with a history of immediate hypersensitivity to penicillins or other beta-lactams owing to the risk of cross-reactivity.
  • It has no useful activity against Pseudomonas aeruginosa, anaerobes or Gram-positive organisms, so it is unsuitable as empirical monotherapy for mixed infections.
  • Dose adjustment is required in renal impairment as it is largely eliminated unchanged by the kidneys.

Monitoring

Monitor renal function to guide dosing and review the full blood count during prolonged parenteral therapy.

Counselling the patient

  • Tell your team about any previous penicillin allergy.
  • It is given by injection or infusion, usually in hospital or via outpatient parenteral therapy.
  • Report rash, diarrhoea or signs of infection at the drip site.

Evidence & guidelines

It is recommended in UK practice as a carbapenem-sparing option for susceptible Gram-negative infections, including those due to ESBL-producing organisms.

Reference: UKHSA AMR; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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