title: Recommendations and current practices for the reconstitution and storage of botulinum toxin type A.
abstract: BACKGROUND
  Current guidelines from the Centers for Disease Control and Prevention (CDC) regarding the reconstitution and storage of botulinum toxin type A (BT-A) differ from those of the Centers for Medicare and Medicaid Services and current clinical practice. CDC guidelines require single-patient use of BT-A vials. Strict adherence to these guidelines creates waste and a significant financial impediment, and does not confer increased protection from infection, assuming standard safe injection practices are followed.
  
  
  OBJECTIVE
  This study examines current clinical practices and provides expert consensus recommendations regarding the reconstitution and storage of BT-A. A review of the literature on the sterility and efficacy of BT-A stored beyond the recommended time period of 4 hours is also presented.
  
  
  METHODS
  An Internet-based survey was used to analyze the current practices of physician members of the American Society for Dermatologic Surgery who administer botulinum type A toxins.
  
  
  RESULTS
  After reconstitution, the majority of physicians (68.6%) routinely store BT-A for a period of greater than 1 week and safely use each toxin vial for more than one patient. Not a single case of infection was observed.
  
  
  CONCLUSIONS
  This was a single survey with a 32.2% response rate.
  
  
  CONCLUSIONS
  A single vial of BT-A can be safely administered to multiple patients, assuming standard safe injection techniques are followed. After reconstitution, Our data suggest that BT-A can be stored beyond the recommended time period of 4 hours.
authors: Department of Dermatology, Division of Mohs Micrographic Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
authors: Austin
authors: A
authors: Liu
authors: Alastair
authors: A
authors: Carruthers
authors: Joel L
authors: JL
authors: Cohen
authors: William P
authors: WP
authors: Coleman
authors: Jeffrey S
authors: JS
authors: Dover
authors: C William
authors: CW
authors: Hanke
authors: Ronald L
authors: RL
authors: Moy
authors: David M
authors: DM
authors: Ozog
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage; D002487:Centers for Disease Control and Prevention, U.S.; D014487:Centers for Medicare and Medicaid Services, U.S.; D004340:Drug Contamination / Q000517:prevention & control; D004356:Drug Storage / Q000592:standards*; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006801:Humans; D007267:Injections / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012965:Sodium Chloride; D014481:United States
chemical_list: D012965:Sodium Chloride; D019274:Botulinum Toxins, Type A