Stability of Meropenem and Piperacillin/Tazobactam with Heparin in Various Peritoneal Dialysis Solutions

Mendes, Karryl; Harmanjeet, Harmanjeet; Sedeeq, Mohammed; Modi, Ankit; Wanandy, Troy; Zaidi, Syed Tabish Razi; Ming, Long Chiau; Castelino, Ronald L.; Sud, Kamal; Peterson, Gregory M.; Patel, Rahul P.

doi:10.3747/pdi.2017.00274

Cited by 13 publications

(11 citation statements)

References 27 publications

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“…Emerging data of piperacillin/tazobactam showed that, when admixed with heparin in dextrose-based and icodextrin-based PD solutions, both drugs are stable for 7 days when refrigerated. 278…”

Section: Initial Presentation and Management Of Peritonitismentioning

confidence: 99%

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

et al. 2022

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Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD and prevention and treatment of such is important in reducing patient morbidity and mortality. The ISPD 2022 updated recommendations have revised and clarified definitions for refractory peritonitis, relapsing peritonitis, peritonitis-associated catheter removal, PD-associated haemodialysis transfer, peritonitis-associated death and peritonitis-associated hospitalisation. New peritonitis categories and outcomes including pre-PD peritonitis, enteric peritonitis, catheter-related peritonitis and medical cure are defined. The new targets recommended for overall peritonitis rate should be no more than 0.40 episodes per year at risk and the percentage of patients free of peritonitis per unit time should be targeted at >80% per year. Revised recommendations regarding management of contamination of PD systems, antibiotic prophylaxis for invasive procedures and PD training and reassessment are included. New recommendations regarding management of modifiable peritonitis risk factors like domestic pets, hypokalaemia and histamine-2 receptor antagonists are highlighted. Updated recommendations regarding empirical antibiotic selection and dosage of antibiotics and also treatment of peritonitis due to specific microorganisms are made with new recommendation regarding adjunctive oral N-acetylcysteine therapy for mitigating aminoglycoside ototoxicity. Areas for future research in prevention and treatment of PD-related peritonitis are suggested.

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Section: Initial Presentation and Management Of Peritonitismentioning

confidence: 99%

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

et al. 2022

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“…11,14,16,19,29 –31 Drug combinations did not cause a significant effect on stability, except for meropenem with heparin in Balance solution which was stable for less than 4 h at body temperature. 31 Meropenem or piperacillin/tazobactam combined with heparin was stable for 3 h at room temperature, but it should be noted that this study assessed stability only at 3 h for this condition. 31 Colouration with or without pH change was observed with the combination of cefazolin and ceftazidime in Extraneal and mixed Balance solution.…”

Section: Resultsmentioning

confidence: 90%

“…In all studies except one, 25 the drug stability was assessed in a PD solution that was contained either in the polyvinyl chloride (PVC) or polyolefin bag. A stabilityindicating assay was utilised in 33% of the studies (n = 7), 12,13,19,23,28,29,31 and an antimicrobial activity assay was reported in 24% of the studies (n = 5). 15,20,22,26,27 Table 1 lists the stability data of b-lactam antimicrobial agents assessed as a single additive to various PD solutions.…”

Section: Resultsmentioning

confidence: 99%

“…23 The stability data of antimicrobial combination agents or antimicrobial agents mixed with heparin are listed in Table 3. 11,14,16,19,[29][30][31] Drug combinations did not cause All studied PD solutions were contained in a polyvinyl chloride bag except Balance which is contained in a polyolefin bag. For PD solutions with two compartments such as Balance and Physioneal, it is denoted if the drug stability was evaluated in the mixed or the unmixed PD solution if the information is reported.…”

Section: Resultsmentioning

confidence: 99%

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Stability and compatibility of intraperitoneal antimicrobials in peritoneal dialysate solutions

Lewis,

Alves,

Ratnam

et al. 2023

Perit Dial Int

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To optimise antimicrobial administration in patients with peritoneal dialysis (PD)-related peritonitis, healthcare providers need literature-based information to develop patient-centred pharmacotherapeutic plans. Traditional PD solutions promote osmosis using dextrose or icodextrin with a lactate buffer. Newer PD solutions have modified the osmotic vehicle and buffer. Knowledge of antimicrobial compatibility and stability with newer PD solutions will assist with determining the route of antimicrobial administration as compatible and stable solutions could be delivered directly to the peritoneum using intraperitoneal administration. This review updates the compatibility and stability of antimicrobial additives in newer PD solutions for PD-related peritonitis.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Several studies have addressed the poor stability of meropenem in aqueous solutions, though not considering the main degradation product, the open-ring metabolite (ORM) form. In the present work, we elucidate the metabolic fate of meropenem and ORM from continuous infusion to the human bloodstream. We performed in vitro infusate stability tests at ambient temperature with 2% meropenem reconstituted in 0.9% normal saline, and body temperature warmed buffered human serum with 2, 10, and 50 mg/L meropenem, covering the therapeutic range. We also examined meropenem and ORM levels over several days in six critically ill patients receiving continuous infusions. Meropenem exhibited a constant degradation rate of 0.006/h and 0.025/h in normal saline at 22 °C and serum at 37 °C, respectively. Given that 2% meropenem remains stable for 17.5 h in normal saline (≥90% of the initial concentration), we recommend replacement of the infusate every 12 h. Our patients showed inter-individually highly variable, but intra-individually constant molar ORM/(meropenem + ORM) ratios of 0.21–0.52. Applying a population pharmacokinetic approach using the degradation rate in serum, spontaneous degradation accounted for only 6% of the total clearance.

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Stability of Meropenem and Piperacillin/Tazobactam with Heparin in Various Peritoneal Dialysis Solutions

Cited by 13 publications

References 27 publications

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

Stability and compatibility of intraperitoneal antimicrobials in peritoneal dialysate solutions

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

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