Physical compatibility of sodium citrate with alcohol and cefepime

Mártha, Csaba; Boddu, Sai H. S.; Churchwell, Mariann D.

doi:10.2146/ajhp120499

Cited by 2 publications

(6 citation statements)

References 7 publications

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“…Prior compatibility and stability studies by our group did not assess the antibiotic susceptibility of the catheter lock solutions. 4,5 In this study, we evaluated antimicrobial activity of each admixture under 4 different conditions at baseline and at 72 hours. After 72 hours, antimicrobial activity ranged from 95% to 106% of the baseline zones of inhibition.…”

Section: Discussionmentioning

confidence: 99%

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Compatibility, Stability, and Efficacy of Vancomycin Combined With Gentamicin or Ethanol in Sodium Citrate as a Catheter Lock Solution

et al. 2017

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Indwelling catheters deliver lifesaving medical treatments for many chronically ill patients but are frequently a source of infection. Treatment may include an antimicrobial agent(s) and anticoagulant solution dwelling within the catheter. In vitro determinations of solution compatibility and stability are necessary prior to use in patients. The aim of this study was to determine the physical compatibility, chemical stability, and antimicrobial activity of vancomycin (5 or 10 mg/mL) with gentamicin (1 mg/mL) or 40% ethanol in 4% sodium citrate lock solution over 72 hours. All solutions were prepared per manufacturer's instructions. Samples were studied under 4 conditions: (1) 25°C with light, (2) 25°C without light, (3) 37°C with light, and (4) 37°C without light. Physical compatibility and chemical stability were assessed at 0, 24, 48, and 72 hours. Antimicrobial susceptibility testing was conducted at 0 and 72 hours. All studies were carried out in triplicate. All solution combinations under each condition remained patent from baseline to 48 hours. One solution combination of vancomycin (5 mg/mL) and ethanol (40% v/v) in 4% sodium citrate revealed a slight turbidity at 72 hours. Clarity and pH remained stable in all other solutions during the entire study period. Chemical compatibility and antibiotic activity ranged from 95% to 105% and 95% to 106% of initial baseline values, respectively, for all solutions under 4 storage conditions. All antibiotic-anticoagulant lock solutions were found to be physically, chemically, and microbiologically stable during the 72-hour study period except vancomycin (5 mg/mL) and ethanol (40% v/v) in 4% sodium citrate solution which showed slight turbidity at 72 hours.

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Section: Discussionmentioning

confidence: 99%

“…A previous study has shown compatibility when cefepime or ethanol is combined with sodium citrate. 4…”

Section: Introductionmentioning

confidence: 99%

Compatibility, Stability, and Efficacy of Vancomycin Combined With Gentamicin or Ethanol in Sodium Citrate as a Catheter Lock Solution

et al. 2017

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“…Our decision to study the admixture combinations, concentrations, and dwell times were based on our previous studies, a review of published literature and the IDSA clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update. [ 3 7 8 ] We chose to study cefazolin with sodium citrate as previous studies have examined cefazolin with heparin. [ 13 14 15 ] Moreover, citrate-based solutions have demonstrated improved clinical outcomes compared to heparin-based solutions.…”

Section: Discussionmentioning

confidence: 99%

“…Our previous studies incorporated ethanol into admixtures with antimicrobial agents and sodium citrate 4% to determine if this additive altered compatibility, antimicrobial susceptibility or stability. [ 7 8 ] Instillation of alternative solutions as a catheter lock solution may offer an option for clinicians combatting limited vascular access and increasing antimicrobial resistance. In addition to systemic antimicrobials, catheter lock solutions may extend catheter life for patients reliant on a catheter for their treatments.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have demonstrated in vitro compatibility of antimicrobial agents and sodium citrate with or without ethanol. [ 7 8 ] Cefazolin, a first-generation cephalosporin is frequently administered systemically to patients with methicillin sensitive gram-positive infections. The national health-care safety network reports the most common bloodstream infection in patients receiving HD was Staphylococcus aureus and that approximately 60% of these infections were methicillin-sensitive organisms.…”

Section: B Ackgroundmentioning

confidence: 99%

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Physical Compatibility, Antimicrobial Activity, and Stability of Cefazolin Combined with Gentamicin or Ethanol in Sodium Citrate as a Catheter Lock Solution

Bachu

Dass

et al. 2021

Journal of Pharmacy and Bioallied Sciences

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Background: Catheters provide vascular access for patients requiring intravenous treatments, but frequently are a source of infection and/or thrombosis. Instilling a solution of an antimicrobial agent with an anticoagulant into the catheter lumen may salvage-infected catheters. Objective: The aim is to evaluate the physical compatibility, antibacterial activity, and stability of varying combinations of cefazolin (10 mg/mL), 40% ethanol, 4% sodium citrate with or without gentamicin (1 mg/mL) as a catheter lock solution over 48 h. Methods: Admixtures were prepared using aseptic technique and stored under four conditions with or without light at 25°C or 37°C. Prepared admixtures were assessed for physical compatibility, antimicrobial susceptibility, and chemical stability in triplicate at 0, 24 and 48 h. Admixture physical compatibility was determined by visual clarity, pH, and ultraviolet (UV) spectroscopy. Antibacterial activity was determined using the Kirby-Bauer disk diffusion method. The chemical stability of cefazolin and gentamicin were assessed using high performance liquid chromatography and UV spectroscopy, respectively. Results: All admixtures maintained clarity for 48 h. All admixtures stored at 25°C and the admixture containing 10 mg/mL cefazolin-4% sodium citrate stored at 37°C sustained antimicrobial activity and were chemically stable. A significant change in pH, antimicrobial activity, cefazolin concentration (<95% of baseline), were observed in admixtures containing ethanol stored at 37°C after 24 h. Gentamicin concentrations remained stable throughout the study. Conclusion: The admixture of 10 mg/mL cefazolin-4% sodium citrate sustained antimicrobial activity over 48 h and was chemically stable. However, admixtures containing ethanol stored at 37°C showed incompatibility with decreased antibacterial activity and cefazolin degradation after 24 h.

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Physical compatibility of sodium citrate with alcohol and cefepime

Cited by 2 publications

References 7 publications

Compatibility, Stability, and Efficacy of Vancomycin Combined With Gentamicin or Ethanol in Sodium Citrate as a Catheter Lock Solution

Compatibility, Stability, and Efficacy of Vancomycin Combined With Gentamicin or Ethanol in Sodium Citrate as a Catheter Lock Solution

Physical Compatibility, Antimicrobial Activity, and Stability of Cefazolin Combined with Gentamicin or Ethanol in Sodium Citrate as a Catheter Lock Solution

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