Compatibility of cefepime and vancomycin during simulated Y-site administration of prolonged infusion

Berti, Andrew D.; Hutson, Paul R.; Schulz, Lucas T; Webb, Aaron P.; Rose, Warren E.

doi:10.2146/ajhp140369

Cited by 13 publications

(8 citation statements)

References 24 publications

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“…Interactions may occur with both intermittent infusion and CI, if different lines are all connected to one single central line, as veins should be preserved and the number of lines is limited. Some drugs, mainly antibiotics, that are frequently administered were tested and found to be compatible (penicillin, carbapenems with the exclusion of imipenem, cefepime, ciprofloxacin, fluconazole, morphine), whereas others were identified as not being compatible or with variable compatibility (most b-lactams, cefotaxime, midazolam, lansoprazole) [75][76][77][78].…”

Section: Neonatologists Need Presentations and Formulations Adjusted Tomentioning

confidence: 99%

How to use vancomycin optimally in neonates: remaining questions

Jacqz-Aigrain

Leroux

Zhao³

et al. 2015

Expert Review of Clinical Pharmacology

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In neonates, vancomycin, a narrow-spectrum antibiotic, is the first choice of treatment of late-onset sepsis predominantly caused by Gram-positive bacteria (coagulase-negative staphylococci and enterococci). Although it has been used for >50 years, prescribing the right dose and dosing regimen remains a challenge in neonatal intensive care units for many reasons including high pharmacokinetic variability, increase in the minimal inhibition concentration against staphylococci, lack of consensus on dosing regimen and way of administration (continuous or intermittent), duration of treatment, use of therapeutic drug monitoring, limited data on short- and long-term toxicity, risk of mutant selection and errors of administration linked to concentrated formulations. This article highlights and discusses future research directions, with specific attention given to dosing optimization of vancomycin, including the advantages of modeling and simulation approaches.

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Section: Neonatologists Need Presentations and Formulations Adjusted Tomentioning

confidence: 99%

How to use vancomycin optimally in neonates: remaining questions

Jacqz-Aigrain

Leroux

Zhao³

et al. 2015

Expert Review of Clinical Pharmacology

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“…However, the zwitterionic character of cefepime eases passage through the protein channels of the outer membrane, showing a broad spectrum against Gram-negative bacteria [3,4,5], and also good activity versus Gram-positive micro-organisms [6]. Alone, combined, or in a rotatory treatment, cefepime seems to be efficient against several bactericidal infections [7,8,9,10].…”

Section: Introductionmentioning

confidence: 99%

Preparation and Characterization of New Liposomes. Bactericidal Activity of Cefepime Encapsulated into Cationic Liposomes

et al. 2019

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Cefepime is an antibiotic with a broad spectrum of antimicrobial activity. However, this antibiotic has several side effects and a high degradation rate. For this reason, the preparation and characterization of new liposomes that are able to encapsulate this antibiotic seem to be an important research line in the pharmaceutical industry. Anionic and cationic liposomes were prepared and characterized. All cationic structures contained the same cationic surfactant, N,N,N-triethyl-N-(12-naphthoxydodecyl)ammonium. Results showed a better encapsulation-efficiency percentage (EE%) of cefepime in liposomes with phosphatidylcholine and cholesterol than with 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine (DOPE). The presence of cholesterol and the quantity of egg-yolk phospholipid in the liposome increased the encapsulation percentage. The bactericidal activity against Escherichia coli of cefepime loaded into liposomes with phosphatidylcholine was measured. The inhibitory zone in an agar plate for free cefepime was similar to that obtained for loaded cefepime. The growth-rate constant of E. coli culture was also measured in working conditions. The liposome without any antibiotic exerted no influence in such a rate constant. All obtained results suggest that PC:CH:12NBr liposomes are biocompatible nanocarriers of cefepime that can be used in bacterial infections against Escherichia coli with high inhibitory activity.

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“…Since then, an applicable study has been performed and exhibits good Y-site stability when using commonly prepared concentrations of cefepime and vancomycin. 25 This patient population also requires consistent availability of intravenous access. There were initial concerns about infusing cefepime over 3 h every 8 h, which could lead to medication administration challenges.…”

Section: Discussionmentioning

confidence: 99%

Extended infusion compared to standard infusion cefepime as empiric treatment of febrile neutropenia

Wrenn

Cluck

Kennedy

et al. 2017

J Oncol Pharm Pract

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Background Extended infusion (EI) dosing provides a longer time above the minimum inhibitory concentration, which is important for the clinical success of β-lactam antibiotics, especially for patients with impaired immunity. The aim of this study was to determine the feasibility and clinical impact of administering cefepime by EI as treatment of febrile neutropenia. Methods This was a prospective, randomized, comparative pilot study. All patients received cefepime 2 g IV every 8 h, with the first dose administered using a 30-min infusion. After the first dose, patients were randomized to receive cefepime over 30 min as a standard infusion (SI) or 3 h (EI). Patients were >18 years old with febrile neutropenia (neutrophil count <500 cells/mm and temperature >38.0ºC) and received chemotherapy or stem cell transplant as treatment for malignancy. Patients were excluded for the following: allergy to a cephalosporin, creatinine clearance (CrCl) < 50 mL/min, receipt of concurrent Gram-negative antimicrobial, sepsis, or solid tumor malignancy. The primary outcome was defervescence by 72 h. Secondary outcomes included time to defervescence, clinical success, in-hospital mortality, hospital length of stay, and need for additional antimicrobials. Main results Sixty-three patients were enrolled: 33 in the SI arm and 30 in the EI arm. The groups were similar with regard to age, gender, weight, estimated creatinine clearance, and duration of neutropenia. None of the patients in the EI arm withdrew due to practical complications of receiving EI cefepime. Twenty-three patients in the SI arm and 20 patients in the EI arm defervesced by 72 h ( p = 0.99). There were no differences in secondary outcome measures; however, patients in the EI arm appeared to have defervesced more rapidly (median 19 vs. 41 h, p = 0.305). Conclusion Administration of cefepime by EI for the treatment of febrile neutropenia is feasible. Larger clinical trials are necessary to determine if EI cefepime imparts a clinical benefit in the treatment of febrile neutropenia.

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Compatibility of cefepime and vancomycin during simulated Y-site administration of prolonged infusion

Abstract: Cefepime and vancomycin were physically and chemically compatible during simulated Y-site administration of prolonged-infusion cefepime.

Cited by 13 publications

References 24 publications

How to use vancomycin optimally in neonates: remaining questions

How to use vancomycin optimally in neonates: remaining questions

Preparation and Characterization of New Liposomes. Bactericidal Activity of Cefepime Encapsulated into Cationic Liposomes

Extended infusion compared to standard infusion cefepime as empiric treatment of febrile neutropenia

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