Stability of benzylpenicillin during continuous home intravenous therapy

Abstract

Significant temperature-dependent degradation of benzylpenicillin occurs during continuous home iv antibiotic programme infusions, which could result in loss of efficacy.

Continuous-infusion penicillin home-based therapy for serious infections due to penicillin-susceptible pathogens

“…We note with concern that a single patient had an undetectable serum penicillin concentration, though this circumstance had no apparent impact on the clinical outcome. Recently a study has been published that demonstrates definite declines of in vitro concentrations of penicillin G under conditions and at temperatures that duplicate those expected with home-based intravenous therapy [17]. In our study, a lower mean serum penicillin concentration was observed in patients whose daily penicillin dose was administered as one 24-h infusion as compared to those who received it as two 12-h infusions, a difference that might be explained by in vitro decomposition of penicillin, however the small number of observations in patients receiving a single 24-h infusion daily and the fact that such patients received a lower mean daily penicillin dose make this finding difficult to interpret.…”

Parenteral antibiotics at home

“…This is an important consideration when giving continuous infusions. During an infusion, temperatures can reach more than 31˚ C. 5,6 Benzylpenicillin, for example, is a useful antibiotic to treat many streptococcal and enterococcal infections. However unless the antibiotic is compounded using a buffer, it rapidly degrades with 1-5% remaining after 24 hours at body temperature.…”

“…However unless the antibiotic is compounded using a buffer, it rapidly degrades with 1-5% remaining after 24 hours at body temperature. 6,7 Meropenem, a carbapenem drug that is often required to treat multidrug resistant pathogens, is poorly stable in solution and is unsuitable for continuous infusions. 8 A strategy where it is compounded and kept in the patient's refrigerator, then given eighthourly rather than as a continuous infusion, helps overcome this problem.…”

Perfusion continue des bêtalactamines : intérêts, inconvénients, modalités pratiques

“…Le Tableau 5, à la lumière des travaux de Vella-Brica et al [34,35], indique clairement l'influence de la tempéra-ture sur la stabilité de la pénicilline G. Le port de poche réfrigérée réduit considérablement la dégradation.…”