Evaluation of the stability of vancomycin solutions at concentrations used in clinical services

Masse, Morgane; Genay, Stéphanie; Mena, Anthony Martin; Carta, Natacha; Lannoy, Damien; Barthélémy, Christine; Décaudin, Bertrand; Odou, Pascal

doi:10.1136/ejhpharm-2019-002076

Cited by 19 publications

(14 citation statements)

References 25 publications

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“…However, since some drugs (coagulation factors, ambisome, fungizone, rifampicin, phenobarbital, insulin) cannot be filtered [ 40 ], the emergency route cannot be systematically filtered. This study and that of Masse et al confirmed that cefepime and vancomycin solutions can be filtered without fear of losing the desired concentration [ 36 ]. Despite there being a low level of particles in caffeine solution compared to the two other drugs, it could be useful to check the concentration of caffeine solution after filtration.…”

Section: Discussionsupporting

confidence: 55%

“…Indeed, other publications have already shown variable particulate loads in the three different formulations of another antibiotic (cefotaxime) [ 35 ]. It would seem that this higher load is more likely to affect generic drugs [ 36 ]. For the cefepime solution, the use of filters is essential: in the absence of incompatibility, they act as a barrier to particulate load while preserving the desired infused cefepime concentration.…”

Section: Discussionmentioning

confidence: 99%

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Optimising an Infusion Protocol Containing Cefepime to Limit Particulate Load to Newborns in a Neonatal Intensive Care Unit

et al. 2021

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Background: In neonatal intensive care units (NICUs), the simultaneous administration of drugs requires complex infusion methods. Such practices can increase the risk of drug incompatibilities resulting in the formation of a particulate load with possible clinical consequences. Methods: This paper evaluates strategies to reduce the particulate load of a protocol commonly used in NICUs with a potential medical incompatibility (vancomycin/cefepime combination). The protocol was reproduced in the laboratory and the infusion line directly connected to a dynamic particle counter to evaluate the particulate matter administered during infusion. A spectrophotometry UV assay of cefepime evaluated the impact of filters on the concentration of cefepime administered. Results: A significant difference was observed between the two infusion line configurations used in the NICU, with higher particulate load for cefepime infused via the emergency route. There was no change in particulate load in the absence of vancomycin. A filter on the emergency route significantly reduced this load without decreasing the cefepime concentration infused. Preparation of cefepime seemed to be a critical issue in the protocol as the solution initially contained a high level of particles. Conclusion: This study demonstrated the impact of a reconstitution method, drug dilution and choice of infusion line configuration on particulate load.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Optimising an Infusion Protocol Containing Cefepime to Limit Particulate Load to Newborns in a Neonatal Intensive Care Unit

et al. 2021

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“…Third, in consideration of the problem of VAN stability and low flow rate (especially in the LRCI phase), some experts consider that OTSI may not be implemented well clinically. However, the concern on the VAN stability is not a factor preventing the implementation of OTSI method since VAN displayed well chemical stability even during 24h infusion (Masse et al, 2020). And, the low flow rate can be performed well with the recently developed microcomputer pumping method.…”

Section: Discussionmentioning

confidence: 99%

Competence Mining of Vancomycin (VAN) in the Management of Infections Due to Bacterial Strains With High VAN Minimum Inhibitory Concentrations (MICs): A Novel Dosing Strategy Based on Pharmacokinetic/Pharmacodynamic Modeling

Song

Zeng

et al. 2021

Front. Microbiol.

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The increasing emergence of bacterial strains with high VAN MICs (BSH–VAN–M), such as Enterococcus faecalis, Enterococcus faecium, Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus bovis, results in growing concern that VAN is not effective against these isolates. Due to the limited data on VAN against BSH–VAN–M and the application limits of drugs currently considered to be effective for BSH–VAN–M, exploration of “new usages for old drugs” is reasonable to improve and maximize the efficacy of existing antibiotics. This study aimed to construct a novel dosing strategy to mine the competence of VAN in the management of BSH–VAN–M infections. Herein, we optimized the traditional intermittent i.v. infusion (TIII) method to create an optimal two-step infusion (OTSI). With pharmacokinetic (PK)/pharmacodynamic (PD) modeling at the targeted ratio of the daily area under the concentration-time curve (AUC0–24) to the minimum inhibitory concentration (MIC) (AUC0–24/MIC) of 400, we used Monte Carlo simulations to evaluate the efficacy of 25 VAN regimens (including 15 OTSI regimens and 10 TIII regimens with daily doses of up to 6 g) to treat pneumonia, meningitis, sternal osteomyelitis, mastitis, pleuritis, bacteremia, and bacterial pericarditis resulting from isolates with MICs of ≤64 mg/L and to the current E. faecalis, E. faecium, S. aureus, S. epidermidis, and S. bovis populations with a pooled MIC distribution. Our data indicated that 4 g/day VAN, with an OTSI but not a TIII, for mastitis, pleuritis, bacteremia, and bacterial pericarditis due to isolates with MICs of ≤4 mg/L or to the current E. faecalis, S. aureus, S. epidermidis, and S. bovis populations achieved the desired PK/PD exposure at the AUC0–24/MIC target of 400. This study suggests the superiority and feasibility of OTSI relative to TIII for the competence mining of VAN against BSH–VAN–M from the perspective of PK/PD and provides a new resource for understanding how PK/PD modeling shapes the performance of VAN to meet the growing challenges of BSH–VAN–M infections.

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“…The stability of vancomycin at room temperature during a slow intravenous infusion is a concern. Therefore, several previous studies have tested the stability of vancomycin for a shorter duration, ranging from 1 h, 48 h, and 17 days when diluted in 5% dextrose or saline at ambient temperature [ 30 , 31 , 32 , 33 , 34 , 35 ]. In agreement with the results of the present study, these studies also demonstrated that vancomycin is stable when stored at room temperature.…”

Section: Discussionmentioning

confidence: 99%

“…The results of the present study extend that stability for a longer duration of 28 days. Further, the data from these previous studies also showed that plastic tubing or iv bags do not cause vancomycin adsorption [ 30 , 31 , 32 , 33 , 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Stability Evaluation of Extemporaneously Compounded Vancomycin Ophthalmic Drops: Effect of Solvents and Storage Conditions

et al. 2021

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Vancomycin is the drug of choice for methicillin-resistant Staphylococcus aureus keratitis and other ocular infections. Vancomycin ophthalmic drops are not commercially available and require compounding. The present study was designed to investigate the stability of vancomycin ophthalmic drops in normal saline, phosphate-buffered saline (PBS), and balanced salt solution (BSS) while stored at room temperature or under refrigeration. Vancomycin ophthalmic drops (50 mg/mL) were aseptically prepared from commercially available intravenous powder using PBS, BSS, and saline. Solutions were stored at room temperature and in a refrigerator for 28 days. The vancomycin stability was tested by a microbiology assay and high-performance liquid chromatography HPLC analysis immediately after formulation and at days 7, 14, and 28 after storage at room temperature or under refrigeration. The pH, turbidity was also tested. Vancomycin formulations in PBS, BSS and normal saline had initial pH of 5; 5.5; 3 respectively. The formulation in PBS developed turbidity and a slight decrease in pH upon storage. Microbiological assay did not show any change in zone of inhibition with any of the formulation upon storage either at room temperature or under refrigeration. HPLC analysis did not detect any decrease in vancomycin concentration or the accumulation of degraded products in any of the formulations upon storage either at room temperature or under refrigeration. Vancomycin ophthalmic drops prepared using PBS, BSS, and normal saline were stable up to the tested time point of 28 days, irrespective of their storage temperature.

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Evaluation of the stability of vancomycin solutions at concentrations used in clinical services

Cited by 19 publications

References 25 publications

Optimising an Infusion Protocol Containing Cefepime to Limit Particulate Load to Newborns in a Neonatal Intensive Care Unit

Optimising an Infusion Protocol Containing Cefepime to Limit Particulate Load to Newborns in a Neonatal Intensive Care Unit

Competence Mining of Vancomycin (VAN) in the Management of Infections Due to Bacterial Strains With High VAN Minimum Inhibitory Concentrations (MICs): A Novel Dosing Strategy Based on Pharmacokinetic/Pharmacodynamic Modeling

Stability Evaluation of Extemporaneously Compounded Vancomycin Ophthalmic Drops: Effect of Solvents and Storage Conditions

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