title: Stability of cefepime in icodextrin peritoneal dialysis solution.
abstract: BACKGROUND
  Icodextrin is a glucose polymer used as an alternative osmotic agent in peritoneal dialysis (PD) solutions. Cefepime may be a suitable antibiotic for the treatment of PD-related peritonitis. The stability of cefepime in icodextrin PD solution has not been examined.
  
  
  OBJECTIVE
  To determine the chemical stability of cefepime in icodextrin PD solution over a 7-day period.
  
  
  METHODS
  Samples were prepared by adding cefepime HCl 1000 mg to commercially available 2.0-L bags of icodextrin 7.5% PD solution. Nine bags were prepared and stored in the following conditions: 3 under refrigeration (4 degrees C), 3 at room temperature (20 degrees C), and 3 at body temperature (37 degrees C). Study samples were drawn from each bag immediately after preparation and at predetermined intervals over the subsequent 7 days. Solutions were visually inspected for precipitation, cloudiness, or discoloration at each sampling interval. Total concentration of cefepime in dialysate fluid was determined by liquid chromatography-tandem mass spectrometry.
  
  
  RESULTS
  Under refrigeration, a mean +/- SD of 95.7 +/-4.2% of the initial cefepime concentration remained at 168 hours (7 days). At room temperature, 92.0 +/- 17.9% remained at 48 hours. At body temperature, 92.2 +/- 4.7% remained at 4 hours. Beyond these respective time points, <90% of the initial cefepime concentrations remained.
  
  
  CONCLUSIONS
  Pre-mixed cefepime-icodextrin PD solutions stored at room temperature were stable for up to 48 hours. However, it is recommended that these be kept refrigerated whenever possible. When refrigerated, cefepime-icodextrin solutions were found to be stable for up to 7 days. Solutions stored at body temperature were stable up to 4 hours, permitting the practice of pre-warming solutions prior to administration.
authors.affiliation: Department of Pharmacy Practice, Albany College of Pharmacy, 106 New Scotland Ave., Albany, NY 12208-3492, USA. elwellr@acp.edu
authors.forename: Rowland J
authors.initials: RJ
authors.lastname: Elwell
authors.forename: Lucio R
authors.initials: LR
authors.lastname: Volino
authors.forename: Reginald F
authors.initials: RF
authors.lastname: Frye
mesh_terms: D000900:Anti-Bacterial Agents / Q000737:chemistry*; D000077723:Cefepime; D002511:Cephalosporins / Q000737:chemistry*; D015314:Dialysis Solutions / Q000737:chemistry*; D004344:Drug Incompatibility; D004355:Drug Stability; D004356:Drug Storage; D005936:Glucans / Q000737:chemistry*; D005947:Glucose / Q000737:chemistry*; D000077607:Icodextrin; D010530:Peritoneal Dialysis; D012034:Refrigeration; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D015314:Dialysis Solutions; D005936:Glucans; D000077607:Icodextrin; D000077723:Cefepime; D005947:Glucose