Stability of antibiotics for intraperitoneal administration in extraneal 7.5% icodextrin peritoneal dialysis bags (stab study)

Ranganathan, Dwarakanathan, Naicker, Saiyuri, Wallis, Steven C., Lipman, Jeffrey, Ratanjee, Sharad K. and Roberts, Jason A. (2016) Stability of antibiotics for intraperitoneal administration in extraneal 7.5% icodextrin peritoneal dialysis bags (stab study). Peritoneal Dialysis International, 36 4: 421-426. doi:10.3747/pdi.2015.00062


Author Ranganathan, Dwarakanathan
Naicker, Saiyuri
Wallis, Steven C.
Lipman, Jeffrey
Ratanjee, Sharad K.
Roberts, Jason A.
Title Stability of antibiotics for intraperitoneal administration in extraneal 7.5% icodextrin peritoneal dialysis bags (stab study)
Journal name Peritoneal Dialysis International   Check publisher's open access policy
ISSN 1718-4304
0896-8608
Publication date 2016-07-01
Year available 2015
Sub-type Article (original research)
DOI 10.3747/pdi.2015.00062
Open Access Status Not yet assessed
Volume 36
Issue 4
Start page 421
End page 426
Total pages 6
Place of publication Milton, ON, Canada
Publisher Multimed
Collection year 2017
Language eng
Formatted abstract
Background and objectives: Patients with peritoneal dialysis (PD)-associated peritonitis may be advised to store PD-bags with pre-mixed antibiotics at home, although there is a paucity of antibiotic stability studies in the commonly used icodextrin solutions. The purpose of this study was to assess the stability of various antibiotics in PD-bags when stored at different temperatures over a 14-day period.

Methods: 7.5% icodextrin PD-bags were dosed with gentamicin 20 mg/L (n = 9), vancomycin 1,000 mg/L (n = 9), cefazolin 500mg/L (n = 9) and ceftazidime 500 mg/L (n = 9) as for intermittent dosing. Combinations of gentamicin/vancomycin (n = 9), cefazolin/ceftazidime (n = 9), and cefazolin/gentamicin (n = 9) were also tested. Nine drug-free bags were used as controls. Bags were stored in triplicate at 37°C, room-temperature (25°C), and refrigeration (4°C). Antibiotic concentrations were quantified at various time intervals using validated chromatography. Storage duration was considered unstable if the concentration of the antibiotic dropped ≤ 90% of the initial value.

Results: Gentamicin was stable for 14 days at all temperatures. Vancomycin was stable for 4 days at 37°C and for 14 days at both 25°C and 4°C. The gentamicin and vancomycin combination was stable for 4 days at 37°C and for 14 days at 25°C and 4°C. Cefazolin alone was stable for 24 hours at 37°C, 7 days at 25°C, and 14 days at 4°C. Ceftazidime alone was stable for only 6 hours at 37°C, 2days at 25°C, and 14 days at 4°C. The cefazolin and ceftazidime combination was stable for 24 hours at 37°C, 2 days at 25°C, and 14days at 4°C. The cefazolin and gentamicin combination was stable for 1 day at 37°C, 4 days at 25°C, and 14 days at 4°C.

Conclusions: Antibiotics premixed in icodextrin PD-bags have varying stabilities with stability generally least at 37°C and best at 4oC, permitting storage for 14 days when refrigerated and pre-warming to body temperature prior to administration. Further research confirming the sterility of these antibiotic-containing bags is recommended.
Keyword Cefazolin
Ceftazidime
Gentamicin
Peritonitis
Stability
Vancomycin
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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