Stability of cefazolin sodium, cefoxitin sodium, ceftazidime, and penicillin G sodium in portable pump reservoirs

Stiles, ML; Tu, Youyou; Lv, Allen

doi:10.1093/ajhp/46.7.1408

Cited by 12 publications

(22 citation statements)

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“…Therefore, cefotaxime is inappropriate for use in OPAT based on our criteria because of lack of evidence. Cefoxitin sequential data showed stability for 30 days at −20°C, then 4 days at 5°C, then 1 day at 37°C 21. Freezing then refrigerating may reduce degradation of the solution as the temperature of the device may be lower than the refrigerated temperature during the thawing phase.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…Cefoxitin is a time-dependent antibiotic. Various studies have shown that cefoxitin is stable for at least 24 h at 24 °C [22][23][24] , allowing its administration as continuous infusion. A study of cefoxitin in the treatment of urinary tract infections due to ESBL-producing E. coli showed that only prolonged infusions of 4 hours could achieve free cefoxitin concentrations above the MIC or 4xMIC during 100% of the administration interval with 76% and 68% probability, respectively, whereas continuous infusion provided 100% probability of achieving MIC and 4xMIC [25] .…”

Section: Pharmacodynamicsmentioning

confidence: 99%

Cefoxitin: A Neglected Intravenous Betalactam with Interesting Perspectives

Cavalli¹,

Dhelft²,

Dupieux³

et al. 2019

mjima

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ÖzCefoxitin is a beta-lactam antibiotic belonging to the cephamycins class, up to now only used in clinical practice for prophylaxis during surgery. Recently, its use has increased due to the spread of infections caused by extended-spectrum beta-lactamase-producing bacteria, particularly urinary tract infections. It has a broad antimicrobial spectrum and is also effective in polymicrobial bone and joint infections or skin and soft tissue infections. Stability data allows its use as a continuous infusion in intensive care units or with elastomeric diffuser for outpatients. Cefoxitin is well tolerated. The aim of this article was to highlight the interesting aspects of this old and inexpensive intravenous beta-lactam.Sefoksitin, sefamisin sınıfına ait bir beta-laktam antibiyotiktir ve şimdiye kadar klinik uygulamada sadece ameliyatlarda profilaksi amacıyla kullanılmaktadır. Yakın zamanda, genişlemiş spektrumlu beta-laktamaz üreten bakterilerin neden olduğu özellikle idrar yolu enfeksiyonları gibi enfeksiyonların yaygınlaşması nedeniyle kullanımı artmıştır. Geniş bir antimikrobiyal spektruma sahiptir ve polimikrobiyal kemik ve eklem enfeksiyonları veya deri ve yumuşak doku enfeksiyonlarında da etkilidir. Stabilite verileri yoğun bakım ünitelerinde sürekli infüzyon olarak veya ayakta tedavi gören hastalarda elastomerik difüzör ile kullanımına olanak sağlamaktadır. Sefoksitin iyi tolere edilen bir antibiyotiktir. Bu makalenin amacı, bu eski ve ucuz intravenöz beta-laktam antibiyotiğin ilgi çekici yönlerini vurgulamaktır.

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Section: Introductionmentioning

confidence: 99%

“…Many studies have investigated drug stability in extended infusions in the outpatient parenteral antimicrobial therapy (OPAT) setting to ensure patients receive their intended dose of therapy. [1][2][3][4][5] However, few studies have investigated the performance of the devices used or specifically any factors that may affect the total dose patients gets in this setting. 6,7 These other factors may result in larger dose deficits for the patient than drug degradation, and must be understood to ensure best possible patient care.…”

Section: Introductionmentioning

confidence: 99%

Total intended antibiotic delivery related to drug concentration affecting the flow rate of elastomeric devices used in outpatient parenteral antimicrobial therapy (OPAT)

Perks

Pain

Franklin

2019

Pharmacy Practice and Res

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Background Many studies have investigated drug stability in extended home infusion pumps, but little is known of other factors that may affect the total daily dose the patient receives. It has been noted that up to 40% of these infusions are incomplete after the designated run out time. Aim This study investigated whether concentration can affect the flow rate of home infusion pumps, and thus the total dose the patient receives in outpatient parenteral antimicrobial therapy (OPAT). Method The flow rates of 10 different drug and dose formulations (4–18 g in 0.9% sodium chloride) in Baxter LV10 (Old Toongabbie, Australia) infusion pumps were investigated. The pumps were run out at 31°C and weighed at intervals, with flow rate and total volume infused calculated over the 24‐h period. Results Piperacillin/tazobactam 18 g was the only formulation not to meet the minimum standard of 90% of the volume being infused over the 24‐h period. This indicates a failure of intended therapy. Across all infusions, the expected dose delivered (DD) can be calculated as %DD = −1.9x + 122.85, where x is the total drug and excipient weight within the infusor. Conclusion Dose is inversely related to flow rate in the LV10 Baxter infusion pump. Under nominal conditions, any amount greater than 12.02 g in the 240‐mL infusion pump will result in an incomplete run out over the 24‐h period. Clinicians should be aware that prescribing daily doses higher than 17.28 g may result in <90% of the intended dose being received by the patient. Further research should investigate whether this decrease in flow rate results in poor clinical outcomes.

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Stability of cefazolin sodium, cefoxitin sodium, ceftazidime, and penicillin G sodium in portable pump reservoirs

Cited by 12 publications

References 0 publications

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

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

Cefoxitin: A Neglected Intravenous Betalactam with Interesting Perspectives

Total intended antibiotic delivery related to drug concentration affecting the flow rate of elastomeric devices used in outpatient parenteral antimicrobial therapy (OPAT)

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