IV Temocillin Dosing Guidance

Temocillin is a beta-lactam antimicrobial with exclusively gram-negative spectrum of activity, but excluding P.aeruginosa. It is only available as an intravenous (IV) formulation.

Antimicrobial Susceptibility

Common gram negative bacillus species (not exhaustive):

  • E.coli
  • Klebsiella species
  • Proteus species

These are only reported as "I" or "R" (see below).

N.B. Pseudomonas aeruginosa is never susceptible to temocillin.

In antimicrobial susceptibility results, temocillin is never reported as “S” = susceptible at standard dosing, but only as “I” = susceptible at increased exposure, or “R” = resistant.1

Table 1: Antimicrobial susceptibility

Susceptibility result Interpretation Appropriate treatment for infection caused by the reported organism? Antimicrobial dosage
I = susceptible at increased exposure High likelihood of therapeutic success, if exposure to the agent is increased Yes Use dosing regimens in Table 2 as recommended by EUCAST1,2
R = resistant High likelihood of therapeutic failure even when there is increased exposure Do not use agent to treat this organism Not applicable

Dosing

  • The standard licensed dosing of temocillin is not applicable.
  • EUCAST guidelines recommend increased temocillin dosing to optimise pharmacodynamics and ensure efficacy against Enterobacterales.1
  • Follow the dosing table below for increased exposure dosing of temocillin.2 Note: this dosing regimen is off-label.3
  • Temocillin dosing requires adjustment for impaired renal function.

Table 2: Temocillin dosing adjusted for renal function

Creatinine Clearance (ml/min) IV Temocillin Dosing Regimen
>60 2g 8-hourly
40 - 60 2g 12-hourly
20 - 40 2g immediately, then 1g 12-hourly
<20 2g immediately, then 1g 24-hourly

 

 

 

References
1. European Society of Clinical Microbiology and Infectious Diseases. EUCAST Clinical Breakpoints Table, Version 11. European Committee on Antimicrobial Susceptibility Testing, Jan 2021. Available at: https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/v_11.0_Breakpoint_Tables.pdf
2. Renal Drug Database; Temocillin (login required via Knowledge Network). Reviewed 28/10/24.
3. NHS Ayrshire & Arran Code of Practice for Medicines Governance, Section 9(b) “Off label” Use of Medicines (link only active if accessing via NHS network).

 

 

Guideline reviewed April 2025
Page updated August 2025



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