Systematic review of stability data pertaining to selected antibiotics used for extended infusions in outpatient parenteral antimicrobial therapy (OPAT) at standard room temperature and in warmer climates

Abstract

AimTo determine if there are sufficient stability data to confirm appropriate prescribing of antibiotics commonly used in outpatient parenteral antimicrobial therapy (OPAT) in warmer climates.Data sourcesFour databases were systematically searched using the terms ‘beta-lactams’, or ‘antibiotics’, or ‘anti-bacterial agents’ and ‘drug stability’ or drug storage’ for studies specific to drug stability published between 1966 and February 2018.Study selectionThe search strategy initially identified 2879 potential articles. After title and abstract review, the full-texts of 137 potential articles were assessed, with 46 articles matching the inclusion and exclusion criteria included in this review.ResultsA large volume of stability data is available for the selected drugs. Stability data at temperatures higher than 25°C were available for several of the medications, however few drugs demonstrated stability in warmer climates of 34°C or higher. Only buffered benzylpenicillin, cefoxitin and buffered flucloxacillin were found to have stability data supporting OPAT in warmer climates. Sequential data, profiling the drug for an extended period in solution under refrigeration prior to the run-out period at the higher temperatures, are also lacking.LimitationsThis study was limited by including only peer reviewed articles. There may be further grey literature supporting the stability of some of the drugs mentioned.ConclusionThere are insufficient stability data of antibiotic use in warmer climates. Studies to verify the stability and appropriate use of many antibiotics used in OPAT at standard room temperature and in warmer climates are urgently required. Several drugs in current use in the OPAT settings are lacking stability data.ImplicationsFurther research in this field is needed to develop structured evidence-based guidelines. Results of this review should be further compared with observed patient outcomes in current clinical practice.

Successful Integration of Clinical Pharmacists in an OPAT Program: A Real-Life Multidisciplinary Circuit

“…In fact, most of the available technical data are obtained at 25 °C [ 95 ], but this is not representative of some periods of the year in the area of our HaH unit, where this is commonly exceeded in spring and summer. This constitutes a problem for extended infusions, although there are publicly available data supporting the use of these perfusions in higher temperature conditions [ 99 , 100 , 101 ]. In our hospital, when the OPAT multidisciplinary circuit was built, a thorough research on the stability times of the most frequently used antibiotics was carried out by specialized pharmacists, using bibliography data for reference.…”

Stability of Antimicrobials in Elastomeric Pumps: A Systematic Review

“…Both chemical stability (percentage of the drug that remains after the storage) and physical stability (changes in color or clearness, pH, and particle formation) should be studied. Therefore, stability data are essential requirements for safety management [ 12 , 13 ]. The aim of this systematic review is to provide a synthesis and a critical evaluation of the current evidence regarding antimicrobial stability in elastomeric 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

“…While the systematic review by Jenkins et al 2 included high-quality information on five key antimicrobial agents, there were a number of papers excluded because they did not include a storage period prior to the in-use stability assessment, or that the ‘in-use’ testing temperature was lower than 32°C. Additionally, Perks et al have highlighted the need to have stability data at temperatures up to 34°C to meet the needs of patients in warmer climates 6. With the increasing global challenge of antimicrobial resistance, and the need to widen the range of agents available to OPAT services worldwide, it is likely that these excluded papers contain useful information to support further investigation of these agents, either to UK YCD or other relevant standards.…”

“…The aim of this review was to extract and summarise the information from these previously excluded papers, to provide useful data to the hospital technical services and OPAT community in order to identify new potential candidates for further stability testing and assessment, to identify those agents which might only be suitable for OPAT services by using a ‘fresh-fill’ approach subject to appropriate safeguards and risk assessments, and to highlight those agents which are not suitable for any model of continuous infusion. The data identified may also be of use for OPAT services outside the UK which do not have a requirement to test at 32°C or where a greater than 5% loss of the active pharmaceutical ingredient (API) is acceptable 6…”