Intravenous lipid emulsions (IVLE) are an important source of energy and essential fatty acids and their incorporation into pediatric and adult parenteral nutrition (PN) regimens has revolutionized nutrition therapy. However, their clinical use has not been without risk, and will continue to remain so because of the intravenous route of administration. Pharmaceutical and microbiological concerns are centered around the methods of compounding all-in-one (AIO) admixtures, but these can be largely minimized with today's technologies and advanced understanding of aseptic principles. Modern lipid products, based on olive, coconut, and/or fish oils, have demonstrable formulation and clinical benefits over traditional soybean and safflower IVLE and, when combined in the new multi-chamber bags, can also offer improvements in stability and safety. This review outlines the rationale for different lipid formulations in PN admixtures, reviews the factors influencing stability and efficacy of lipid-based AIO regimens and evaluates some technologies for minimizing peroxidation and maximizing stability of AIO admixtures.
Weread with interest the letterby Rappand Kuhn' and the commentby Gin et aU on the warninglenersfrom the manufacturer and the Food and Drug Administration relatedto the ceftriaxone-calciurn precipitation issue.Given the huge differences betweenneonatal and adult patient dosages and pharmacokinetics,the recommendation that adults should not receive calcium-containing products or ceftriaxone within 48 hoursof each other is, in our opinion,somewhat exaggerated. The usual adult dosage of ceftriaxone is 1-2 g administered once a day. Only in severe infectionsshould the daily dosage be raised to 4 g. Thus, for a patientweighing 70 kg, we calculatethe following dosages: 1000 mg/70 kg =14mg/kg/day,2000 mg170 kg = 29 mg/kg/day,and 4000 mg/70 kg = 57 mg/kg/day. In contrast,infantsand young children
Administration of H2-receptor antagonists in parenteral nutrition admixtures has several clinical and economical advantages, but, in order for these benefits to be well tolerated and efficacious, the stability and compatibility of the drugs, as well as the parenteral nutrition components after mixing, have to be ascertained. Factors that influence stability are assessed, the need for more controlled study protocols is evaluated and recommendations are made for safe storage and administration.
The clinical homecare sector is often associated with high-cost drug parenteral (injectable) therapy treatments and has been rapidly growing in the United Kingdom (UK) at a 20% annual rate. It was estimated that this could further rise to 60% if extended to all medicines that are considered to be suitable for care at home. The latest data shows that the homecare medicines services sector continues to grow in number and complexity, with over 500,000 patients and a spend of UK£3.2 billion in 2021. Given the extent of the National Health Service (NHS) expenditure and the number of patients involved, it is essential to understand and explore the patients' and HCPs' experiences, views, and perceptions of this therapy. As identified during this literature review, homecare provides opportunities for improved cost savings and improved patient experience, but several issues have already been reported worldwide. Patient education, training, support, and regular supervision, as well as the competency of HCPs to manage these patients, have all been identified as factors that contribute to the success or failure of self-administration of parenteral therapy at home, which might impact treatment outcomes and adherence. This is an area that needs urgent research.
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