title: Prolonged stability of antimicrobial activity in peritoneal dialysis solutions.
abstract: OBJECTIVE
  To evaluate the stability of the antimicrobial chemical and bioactivity of gentamicin, vancomycin, and gentamicin and vancomycin in combination, and the stability of the bioactivity of ceftazidime, admixed in standard peritoneal dialysis solutions and then maintained over a 14-day period at room temperature or under refrigeration.
  
  
  METHODS
  Peritoneal dialysis center and microbiology laboratory at a military, teaching medical center.
  
  
  METHODS
  Standard peritoneal dialysate bags admixed with gentamicin, vancomycin, gentamicin and vancomycin in combination, or ceftazidime were stored at either 4 degrees C or 20 degrees C for 14 days. Sequential aliquots were withdrawn and assayed for antibiotic activity by bioassay and, except for ceftazidime, immunoassay for chemical activity. The bioassay was performed using a standardized Kirby-Bauer disc method. Significance was determined by ANOVA and, where the effect size was significant at the p < 0.05 level, the application of the paired t-test or the Wilcoxon signed rank test to the difference in activity between the first and last samples.
  
  
  RESULTS
  Antibiotic concentration by immunoassay did not significantly deteriorate over 14 days for vancomycin or gentamicin when either room temperature or refrigerated samples were studied. By bioassay, gentamicin and ceftazidime, but not vancomycin, lost moderate but significant activity over 14 days when refrigerated bags were assayed (except for an insignificant decrement in gentamicin in the combined vancomycin and gentamicin bags). Bags stored at room temperature, in general, lost significant bioactivity over 14 days, but to levels where clinical efficacy would still be expected. The vancomycin bioassay performed on the combination bags demonstrated a remarkably enhanced bioactivity, presumably reflecting synergy with gentamicin.
  
  
  CONCLUSIONS
  These data indicate that the study antibiotics admixed with peritoneal dialysis fluids retain stable chemical activity, whether refrigerated or kept at room temperature, for at least 14 days. A moderate decrement in bioactivity occurred for study antibiotics when stored either refrigerated or at room temperature over 14 days, although clinically significant levels were maintained. The clinical significance of a possible synergy between vancomycin and gentamicin is yet to be determined.
authors.affiliation: Department of Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas 78234, USA. david.dooley@cen.amedd.army.mil
authors.forename: David P
authors.initials: DP
authors.lastname: Dooley
authors.forename: J Robert
authors.initials: JR
authors.lastname: Tyler
authors.forename: William G
authors.initials: WG
authors.lastname: Wortham
authors.forename: Linda S
authors.initials: LS
authors.lastname: Harrison
authors.forename: William F
authors.initials: WF
authors.lastname: Starnes
authors.forename: George R
authors.initials: GR
authors.lastname: Collins
authors.forename: Irene S
authors.initials: IS
authors.lastname: Ozuna
authors.forename: Patty L
authors.initials: PL
authors.lastname: Violet
authors.forename: John A
authors.initials: JA
authors.lastname: Ward
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001419:Bacteria; D002442:Ceftazidime / Q000494:pharmacology*; D015314:Dialysis Solutions / Q000378:metabolism*; D004355:Drug Stability; D004357:Drug Synergism; D005839:Gentamicins / Q000494:pharmacology*; D010530:Peritoneal Dialysis / Q000379:methods*; D013696:Temperature; D014640:Vancomycin / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D015314:Dialysis Solutions; D005839:Gentamicins; D014640:Vancomycin; D002442:Ceftazidime