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. david.livermore@hpa.org.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] Related Links Continuous versus intermittent infusion of temocillin, a directed spectrum penicillin for intensive care patients with nosocomial pneumonia: stability, compatibility, population pharmacokinetic studies and breakpoint selection. [J Antimicrob Chemother. 2008] PMID:18070831 Comparative review of the carbapenems. [Drugs. 2007] PMID:17488146 In vitro activity of temocillin against extended spectrum beta-lactamase-producing Escherichia coli. [J Antimicrob Chemother. 2006] PMID:16501056 [The history of the development and changes of quinolone antibacterial agents] [Yakushigaku Zasshi. 2003] PMID:15143768 Impact of changing pathogens and antimicrobial susceptibility patterns in the treatment of serious infections in hospitalized patients. [Am J Med. 1996] PMID:8678095