Simultaneous infusion of two incompatible antibiotics: Impact of the choice of infusion device and concomitant simulated fluid volume support on the particulate load and the drug mass flow rates

Négrier, Laura; Mena, Anthony Martin; Lebuffe, Gilles; Maury, Éric; Gaudy, Romain; Degand, Flavie; Thibaut, Manon; Carta, Natacha; Odou, Pascal; Genay, Stéphanie; Décaudin, Bertrand

doi:10.1016/j.ijpharm.2022.122220

Cited by 2 publications

(6 citation statements)

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“…In an in vitro study, we evaluated the influence of various strategies used in healthcare facilities to limit the occurrence of drug incompatibilities. We focused on the simultaneous infusion of VPT and the well-known incompatibility between the two components [ 18 , 19 , 41 , 42 ]. Our experiments highlighted the influence of vancomycin dilution on the particulate load generated by VPT drug incompatibility.…”

Section: Discussionmentioning

confidence: 99%

“…According to the SmPC for vancomycin, WFI is recommended for reconstitution, followed by SS for dilution [ 43 ]. According to the literature, the particulate load and/or the vancomycin solution concentration are not compliant when vancomycin is not reconstituted with WFI [ 18 , 44 , 45 ]. Our results confirmed this: only vancomycin reconstituted with WFI meets EP standards [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

“…The drugs were assayed with an HPLC-UV method developed in our laboratory [ 18 ]. First, the compounds were separated on a reverse-phase C18 analytical column (Gemini ® 150 × 4.6 mm, 5 μm particle size, Phenomenex, Le Pecq, France) in gradient elution mode.…”

Section: Methodsmentioning

confidence: 99%

“…The sequential infusion of two incompatible drugs (interspersed by flushing of the infusion line) is only possible if neither is infused continuously [ 29 , 30 , 31 , 32 , 33 , 34 ]. For this reason, another approach involves limiting the contact between solutions and/or decreasing the consequences of this contact by (for example) in-line filtration [ 35 , 36 , 37 ], a particular infusion line geometry [ 18 , 38 ], minimization of the drug concentrations [ 38 ], the use of a multilumen line, and infusion devices with a low residual volume [ 18 , 38 , 39 ]. However, the application of these strategies in isolation might not be sufficient to control the risks.…”

Section: Introductionmentioning

confidence: 99%

“…The vancomycin-piperacillin/tazobactam (VPT) combination is recommended in several clinical guidelines as the empirical first-line treatment for a number of serious infections [13][14][15][16]. However, a white precipitate may form when the two antibiotics come into contact [17][18][19][20]. Furthermore, a large number of studies have documented the elevated risk of nephrotoxicity associated with the VPT combination [21][22][23].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Strategies for Reducing Vancomycin-Piperacillin/Tazobactam Incompatibility

Martin Mena,

Négrier,

Treizebré

et al. 2023

Pharmaceutics

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Background: Drug incompatibility is defined as a physical-chemical reaction between two or more injectable drugs and that results mainly in precipitation or insolubility. Several strategies for reducing incompatibilities have been implemented empirically in intensive care units. However, these strategies have never been compared directly (and particularly in terms of the particulate load and drug mass flow rate) under standardized conditions. The objective of the present in vitro study was to evaluate the impact of various strategies for preventing incompatibility between simultaneously infused vancomycin and piperacillin/tazobactam. Methods: An in-line filter, a dilute vancomycin solution (5 mg/mL), and an alternative saline administration line were evaluated separately. The infusion line outlet was connected to a dynamic particle counter. The antibiotic concentration was measured in an HPLC-UV assay. Result: The use of an in-line filter and an alternative saline administration route did not significantly reduce the particulate load caused by vancomycin-piperacillin/tazobactam incompatibility. Dilution of the vancomycin solution was associated with a significantly lower particulate load and maintenance of the vancomycin mass flow rate. Discussion: It is important to systematically compare the efficacy of strategies for preventing drug incompatibility. The use of diluted vancomycin solution gave the best results in the case of vancomycin-piperacillin/tazobactam incompatibility.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of Strategies for Reducing Vancomycin-Piperacillin/Tazobactam Incompatibility

Martin Mena,

Négrier,

Treizebré

et al. 2023

Pharmaceutics

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Evaluation of the Impact of Infusion Set Design on the Particulate Load Induced by Vancomycin–Piperacillin/Tazobactam Incompatibility

Négrier,

Décaudin,

Treizebré

et al. 2024

Pharmaceuticals

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Introduction: Drug incompatibilities are among the most common medication errors in intensive care units. A precipitate can form and block the catheter or cause an adverse event in the patient. Intensive care units have implemented various strategies for limiting the occurrence of these incompatibilities, which have already been studied in vitro under standardized conditions. The objective of the present in vitro study was to continue these assessments by determining the impact of the infusion line geometry and the drugs’ position in the infusion set-up on the prevention of vancomycin–piperacillin/tazobactam incompatibility. Methods: Infusion lines with a different common volume, a multilumen medical infusion device, a dilute vancomycin solution, and separate infusions of incompatible drugs were evaluated separately. The infusion line outlet was connected to a dynamic particle counter. Results: Reducing the common volume, using multilumen medical devices, or spacing out the two incompatible drugs on the infusion line did not prevent the occurrence of a significant particulate load. Only dilution of the vancomycin solution was associated with a significantly lower particulate load and the absence of drug incompatibility. Conclusions: Our results show that under specific conditions, it is possible to reduce particulate contamination considerably.

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Simultaneous infusion of two incompatible antibiotics: Impact of the choice of infusion device and concomitant simulated fluid volume support on the particulate load and the drug mass flow rates

Cited by 2 publications

References 57 publications

Evaluation of Strategies for Reducing Vancomycin-Piperacillin/Tazobactam Incompatibility

Evaluation of Strategies for Reducing Vancomycin-Piperacillin/Tazobactam Incompatibility

Evaluation of the Impact of Infusion Set Design on the Particulate Load Induced by Vancomycin–Piperacillin/Tazobactam Incompatibility

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