Stability of Antimicrobials in Elastomeric Pumps: A Systematic Review

Abstract

Outpatient parenteral antimicrobial therapy (OPAThttp) programs have become an important healthcare tool around the world. Portable elastomeric infusion pumps are functional devices for ambulatory delivery of antimicrobial drugs, and their stability is an essential point to guarantee an appropriate infusion administration. We conducted a systematic review to provide a synthesis and a critical evaluation of the current evidence regarding antimicrobial stability in elastomeric pumps. Data sources were PubMed, EMBASE, and Web of Sciences. The review protocol was registered on the Center for Open Science, and it was carried out following the PRISMA guidelines. Studies were eligible if the aim was the evaluation of the physicochemical stability of an antimicrobial agent stored in an elastomeric device. Of the 613 papers identified, 33 met the inclusion criteria. The most studied group of antimicrobials was penicillins, followed by cephalosporins and carbapenems. In general, the stability results of the antimicrobials that have been studied in more than one article agree with each other, with the exception of ampicillin, flucloxacillin, and ceftazidime. The antibiotics that displayed a longer stability were glycopeptides and clindamycin. Regarding the stability of antifungals and antivirals, only caspofungin, voriconazole, and ganciclovir have been investigated. The information provided in this article should be considered in patient treatments within the OPAT setting. Further stability studies are needed to confirm the appropriate use of the antimicrobials included in this program to ensure optimal patient outcomes.

Prepared omadacycline for injection: Nine-day stability and sterility in an elastomeric pump

“…The stability and sterility of compounded products are important for patient safety and should be informed by best practices 7 and evidence from the assessment of similar products with similar endpoints. 8 , 9 This study assessed a SMARTeZ® device based upon requests from healthcare providers for additional stability and sterility data with this device. Patients in which the SMARTeZ® device is not available may utilize omadacycline as prepared in the prescribing information with a standard infusion bag administered using gravity or an additional pump.…”

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

“…In fact, the frequency of visits by our HaH unit at patients’ homes is determined by drug stability (unless a patient requires special medical assistance), as it occurs with the scheduling of workflows at the pharmacy department. Information on antimicrobial stability in elastomeric pumps can be obtained through distinct sources: databases from elastomeric pump manufacturers (with access usually restricted to customers), the Stabilis ® database, systematic published reviews [ 94 , 95 , 96 ], official guidelines or consensus documents [ 10 , 65 ], or specific publications about a single antimicrobial or family [ 97 , 98 ]. Sometimes, a lack of stability data or short stability time are the main factors that prevent a patient from entering an OPAT program or cause the replacement of an initially prescribed antimicrobial.…”

“…Moreover, the weather conditions of the area also influence antimicrobial stability. 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 ].…”

“…Consequently, our stability data are periodically updated when required. Unfortunately, there are insufficient data on the stability of some antimicrobials (e.g., cotrimoxazole or anidulafungin) [ 95 , 102 ], and they are not yet included in our OPAT program.…”

Stability of Ampicillin plus Ceftriaxone Combined in Elastomeric Infusion Devices for Outpatient Parenteral Antimicrobial Therapy

“…Among the limitations, the long-term use of elastomeric devices is more expensive than the one-time purchase of an electric infusion pump and the associated disposables, although continuous elastomeric pump infusion reduces the number of daily nurse visits [ 11 , 12 ]. Moreover, environmental factors such as the external temperature need to be taken into account, as they could affect the stability of the antimicrobials [ 13 ].…”