Antibiotic stability in portable elastomeric infusion devices: A systematic review

Abstract

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Although outpatient parenteral antibiotic therapy (OPAT) can be a good approach to treatment of infections, a lack of data regarding antibiotic stability in portable elastomeric infusion devices restricts its safe, appropriate, and effective use. The objective of this work was to complete a systematic peer-reviewed analysis of published articles about antibiotic stability in elastomeric infusion devices that provide evidence supporting their use in OPAT. Summary A systematic review following PRISMA guidelines was conducted in January 2021 to identify published articles about antibiotic stability in portable elastomeric infusion devices. The databases used were PubMed, Embase, Web of Science, and a Cochrane database. A total of 1,615 original studies and conference communications were found. After title, abstract, and full-text review, 33 articles met the inclusion criteria. The data obtained included information about the stability of 30 different antibiotics. To our knowledge, this is the first review to summarize the available published data on the stability of antibiotics in portable elastomeric infusion devices. The results highlight the poor stability of some antibiotics in solution and the variability of the laboratory conditions in the included studies. Conclusion This systematic review can serve as a useful resource for healthcare professionals involved in providing OPAT using portable elastomeric infusion devices. However, further stability studies should be performed, especially high-quality studies simulating real-life time and temperature conditions.

Feasibility, Effectiveness and Safety of Elastomeric Pumps for Delivery of Antibiotics to Adult Hospital Inpatients—A Systematic Review

“…The only paper that met the criteria was Cave et al [ 18 ] ( n = 6), an observational case series. Egerer et al was initially thought to be suitable, but on further investigation, this was excluded as the infusion pumps used were battery powered [ 19 ]. Another paper, Hubert et al [ 15 ], was excluded due to the lack of information about the number of participants treated as inpatients.…”

Ampicillin Stability in a Portable Elastomeric Infusion Pump: A Step Forward in Outpatient Parenteral Antimicrobial Therapy

“…All these aspects are critical to ensure drug stability as they determine therapeutic efficacy, safety, and the emergence of resistant microorganisms [ 44 ]. Numerous studies have been published recently, favoring the use of this strategy [ 1 , 10 , 22 ]; however, AMP has not been routinely included in OPAT precisely because of its limited stability after more than 24 h at room temperature, especially in countries with warmer climates [ 45 ].…”

“…Outpatient parenteral antimicrobial therapy (OPAT) is defined as the administration of intravenous antimicrobial therapy in a community or outpatient setting as an alternative to hospitalization [ 1 ]. Several organizations, including the Infectious Diseases Society of America (IDSA), the British Society for Antimicrobial Chemotherapy (BSAC), and the Spanish Family Hospitalization Association, have developed guidelines for the implementation of OPAT [ 2 , 3 , 4 ].…”

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“…As previously stated, syncytia are cellular clusters that share the same area within a single lipid membrane but contain several cell nuclei. This superstructure permits viral genetic material to be transported between cells without being released into the cellular space, resulting in a very efficient transmission system that also hides the virus from immune system action [55] (Figure 2). One implication of syncytia formation is that the peak viral load occurs later than in other viral infections that do not induce syncytia [56,57].…”