Stability and compatibility of antimicrobial lock solutions

Bookstaver, P. Brandon; Rokas, Kristina; Norris, LeAnn B.; Edwards, James; Sherertz, Robert J.

doi:10.2146/ajhp120119

Cited by 35 publications

(38 citation statements)

References 95 publications

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“…Simulated Y-site compatibility study of daptomycin 19.6mg/mL and heparin 98units/mL demonstrated physical and chemical stability for up to 120 minutes at room temperature. 26 In this same study, daptomycin 19.2mg/mL and gentamicin 1.5mg/mL were shown to be physically compatible and chemically stable at 2 hours. 26 In the present study, we investigated up to 96-hour stability and compatibility, confirming 48-hour daptomycin stability at room temperature for all candidate solutions, including heparin concentrations at 1,000 and 100 units/mL.…”

Section: Discussionmentioning

confidence: 75%

“…18 To date, physical stability and chemical compatibility data of daptomycin with antibiotics and anticoagulants in lock solution are limited and exclude lock solutions that may be used in clinical practice. 19 We sought to investigate the 96-hour compatibility and stability of daptomycin 1mg/mL, reconstituted with LR solution, in combination with gentamicin, azithromycin, and heparin or citrate. We also report a brief review of the available compatibility and stability data of daptomycin in lock solutions.…”

Section: Introductionmentioning

confidence: 99%

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Compatibility and Stability of Daptomycin Lock Solutions in Combination with Gentamicin, Azithromycin, Heparin and Trisodium Citrate

Bookstaver¹,

Premnath²,

K³

et al. 2019

Preprint

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Background: Antibiotic lock therapy is an interventional modality used for treatment and prevention of central-line associated bloodstream infections. Stability and compatibility data for combinations are lacking, limiting clinical use. Objective: Compatibility and stability of daptomycin lock solutions in combination with azithromycin, gentamicin, and heparin or sodium citrate were evaluated up to 96 hours. Methods: Eight candidate lock solutions were prepared for compatibility and stability testing. All solutions were prepared in glass vials, and included daptomycin 1mg/mL in varying combinations with heparin 100 – 1,000 units/mL, trisodium citrate, azithromycin and/or gentamicin. Lactated Ringer’s solution was added as a diluent in a sufficient quantity to bring the total volume up to 5mL. Drug stability in the admixture was determined by the degradation of the components. The quantification of drugs was performed using Waters Alliance HPLC using Phenomenex Luna C8 (2), 150*2.6mm, 5µ column. A gradient run was executed for 20 minutes with 0.45% ammonium dihydrogen phosphate, pH 3.25 as eluent A and acetonitrile as eluent B at a flow rate of 1.0mL/min. Each solution was visually inspected for particulates and color change. Lock solutions were tested in triplicate. Results: Daptomycin degradation was <10% for all solutions at 48 hours, and for 7 of the 8 solutions at 72 hours. Gentamicin degradation was <5% for solutions in combination with daptomycin and trisodium citrate. No physical incompatibilities were detected. Conclusion: Study data support the stability and compatibility of daptomycin with additives in solution, allowing for fewer exchanges and longer dwell times for a lock solution. The addition of azithromycin or gentamicin may offer synergy and/or extended spectrum of activity. Daptomycin bioactivity with trisodium citrate needs confirmation.

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Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Compatibility and Stability of Daptomycin Lock Solutions in Combination with Gentamicin, Azithromycin, Heparin and Trisodium Citrate

Bookstaver¹,

Premnath²,

K³

et al. 2019

Preprint

Self Cite

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“…La terapia de sellado se define como la instilación de una solución antimicrobiana, con o sin combinación con un anticoagulante (heparina, por ejemplo), en el lumen del CVC, sellándolo mientras éste no se usa, con el objetivo de prevenir la colonización y la formación de biopelícula y coágulos para reducir las IACVC y así prolongar la vida útil del dispositivo 16 . La solución ideal para la terapia de sellado 17 debe mantener una concentración efectiva para dificultar la adhesión microbiana, ser estable y compatible con eventuales aditivos, no inducir resistencia, no absorberse a la circulación sistémica, ni provocar eventos adversos.…”

Section: Terapia De Sellado Como Prevención De Las Iacvcunclassified

Taurolidina, un antiséptico para la prevención de infecciones asociadas a catéter venoso central

Haro

2019

Rev. chil. infectol.

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“…172 It remains stable for 96 hours, with and without associated heparin. 229 It can combine with 100 IU/mL heparin, 225 and with amikacin and gentamicin for polymicrobial infections. 230 Teicoplanin 10,000 mg/L has shown superior efficacy to vancomycin 2,000 mg/L.…”

Section: What Antibiotics and Concentrations Of Antibiotic Lock Solutmentioning

confidence: 99%

“…225,231 Ringer's lactate should be added to the solution. The solution remains stable with and without heparin for 96h, 229 and can be combined with heparin 100, 400 and 5,000 IU/mL and 4% sodium citrate (daptomycin 5,000 mg/L), as well as with 25% ethanol. 232 In a study of 13 cases, daptomycin 5,000 mg/L achieved an 85% clinical cure rate.…”

Section: What Antibiotics and Concentrations Of Antibiotic Lock Solutmentioning

confidence: 99%

Executive summary: Diagnosis and Treatment of Catheter-Related Bloodstream Infection: Clinical Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) and the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC)

Cháves

Garnacho-Montero

Pozo

et al. 2018

Enfermedades Infecciosas y Microbiología Clínica

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Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Sthaphylococcus aureus, Enterococcus spp, Gram-negative bacilli, and Candida spp), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.

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Stability and compatibility of antimicrobial lock solutions

Abstract: Pharmacists' knowledge of diverse combinations of antimicrobial agents and additives in lock solutions, including several shown to be stable and compatible for extended periods, can help expand and optimize the use of ALT in both treatment and prophylactic modalities.

Cited by 35 publications

References 95 publications

Compatibility and Stability of Daptomycin Lock Solutions in Combination with Gentamicin, Azithromycin, Heparin and Trisodium Citrate

Compatibility and Stability of Daptomycin Lock Solutions in Combination with Gentamicin, Azithromycin, Heparin and Trisodium Citrate

Taurolidina, un antiséptico para la prevención de infecciones asociadas a catéter venoso central

Executive summary: Diagnosis and Treatment of Catheter-Related Bloodstream Infection: Clinical Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) and the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC)

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