Stability of antimicrobial agents in an elastomeric infusion pump used for outpatient parenteral antimicrobial therapy

Abstract

The long-term stability of antimicrobials dissolved in infusion solution is necessary to establish and spread the outpatient parenteral antimicrobial therapy (OPAT). In this study, we evaluated the stability of antimicrobial agents dissolved in infusion solutions. Methods: The antimicrobial agents were dissolved in infusion solutions and kept at 25 C and 31.1 C for 24 h or 4 C for 10 days in a polypropylene tube or an elastomeric infusion pump. The stability was measured by high-performance liquid chromatography. Results and conclusion: The residual ratio of cefazolin (CEZ), cefmetazole (CMZ), piperacillin (PIPC), and tazobactam (TAZ) at 31.1 C for 24 h was as follows: 95.7 AE 3.0%, 94.8 AE 0.9%, 102.6 AE 1.8%, and 103.9 AE 3.6% in saline, respectively; 94.7 AE 3.0%, 94.3 AE 1.5%, 106.1 AE 3.0%, and 107.3 AE 2.4% in 5% dextrose solution, respectively. The residual ratio of these antimicrobials at 4 C for 10 days was maintained above 90% in both saline and 5% dextrose solution. The residual ratio of all the above antimicrobials in an elastomeric infusion pump at 31.1 C for 24 h was equivalent to that in the polypropylene tube. On the other hand, doripenem and meropenem were not stable in any infusion solution at 31.1 C. CEZ, CMZ, and PIPC/TAZ dissolved in saline or 5% dextrose solution can be used in OPAT with continuous infusion pumps.

Widening the net: a literature review of antimicrobial agents with potential suitability for outpatient parenteral antimicrobial therapy services—the importance of storage and stability

“…Akahane et al studied the stability of cefmetazole 8 g diluted in 240 mL of either sodium chloride 0.9% or glucose 5% in Baxter LV10 infusers and stored at 31.1°C. The percentages of API remaining at 24 hours were reported as 92.9±0.8% and 92.4±0.8%, respectively 9. Limitations to this paper were previously described above.…”

“…Cefazolin 6 g in 240 mL sodium chloride 0.9% or glucose 5% in Baxter LV10 infusers and stored at 31.1°C was reported by Akahane et al . Only data for the 24-hour time point are presented with 94.4% API remaining for both diluents 9. A further study reported cefazolin 1 g in 1000 mL glucose 5% stored in Ecoflac infusion bags at 35°C demonstrated more than 90% of cefazolin remaining at 48 hours 10.…”

“…The stability of doripenem 3 g in 240 mL stored in Baxter LV10 infusers at 31.1°C was investigated using the five diluents used in the Nakamura et al 8 study of ampicillin. Little data were reported other than that stability was optimal in Acetate Ringers solution for which residual percentage of doripenem was 88.7±0.3% at 24 hours 9…”

Stability of Antimicrobials in Elastomeric Pumps: A Systematic Review

“…The principal characteristics of each antimicrobial group, such as drug, reference [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ], main conditions (composition of the elastomeric device chosen, concentration, diluent, temperature, and duration of storage), chemical and physical stability obtained, and the most relevant comments for the systematic review, are summarized in Table 1 , Table 2 , Table 3 , Table 4 , Table 5 , Table 6 , Table 7 and Table 8 .…”

The Role of Non-Enzymatic Degradation of Meropenem—Insights from the Bottle to the Body

“…According to the European and United States Pharmacopoeia, stability of an infusate is only given when the drug concentration remains above 90% of the initial concentration during the entire infusion interval [11,12]. Numerous studies have investigated the stability of meropenem in aqueous solutions at various conditions, including antibiotic concentration, temperatures and pH values [13][14][15][16][17][18][19][20][21][22][23]. All these studies focused solely on in vitro stability data.…”