title: Stability and compatibility of antimicrobial lock solutions.
abstract: OBJECTIVE
  Published stability and compatibility data on a growing array of solutions used for antimicrobial lock therapy (ALT) are reviewed.
  
  
  CONCLUSIONS
  ALT involves the instillation of a highly concentrated antimicrobial, often in combination with an anticoagulant, into a central venous catheter (CVC) lumen; this technique is often used for prophylaxis after CVC insertion or as an adjunctive treatment in cases of central line-associated bloodstream infection (CLABSI) if catheter removal is not feasible. Optimal selection of stable and compatible antimicrobials and additives can maximize catheter dwell times, streamline pharmacy compounding practices, and help ensure patient safety. Of 98 articles on ALT solutions identified in a literature search, 17 met the prespecified criteria for the use of validated stability and compatibility methodology. Antimicrobials active against common CLABSI pathogens that may be appropriate for ALT include cefazolin, cefotaxime, ceftazidime, ciprofloxacin, daptomycin, gentamicin, linezolid, telavancin, ticarcillin-clavulanic acid, and vancomycin; validated data demonstrate the stability of these agents in solution with heparin or nonheparin anticoagulants over 72-96 hours or longer. Other antifungal agents and antiinfectives (e.g., ethyl alcohol) have been used in specific patients and ALT situations. The prolonged stability of several antimicrobial-additive combinations may allow for extended dwell times and less frequent lock solution exchanges.
  
  
  CONCLUSIONS
  Pharmacists' knowledge of diverse combinations of antimicrobial agents and additives in lock solutions, including several shown to be stable and compatible for extended periods, can help expand and optimize the use of ALT in both treatment and prophylactic modalities.
authors.affiliation: P. Brandon Bookstaver, Pharm. D., BCPS (AQ-ID), AAHIVP, is Associate Professor and Vice Chair, Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy (SCCP), University of South Carolina Campus, Columbia. Kristina E. E. Rokas, Pharm.D., is Postgraduate Year 2 Infectious Diseases Resident, Department of Pharmacy, Wake Forest Baptist Health, Winston-Salem, NC. LeAnn B. Norris, Pharm.D., BCPS, BCOP, is Assistant Professor, Department of Pharmacy Practice and Outcomes Sciences; and Julie M. Edwards is a Pharm.D. candidate, SCCP, University of South Carolina Campus. Robert J. Sherertz, M.D., is Professor Emeritus, School of Medicine, Wake Forest University, Winston-Salem.
authors.forename: P Brandon
authors.initials: PB
authors.lastname: Bookstaver
authors.forename: Kristina E E
authors.initials: KE
authors.lastname: Rokas
authors.forename: LeAnn B
authors.initials: LB
authors.lastname: Norris
authors.forename: Julie M
authors.initials: JM
authors.lastname: Edwards
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sherertz
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000737:chemistry; D000925:Anticoagulants / Q000008:administration & dosage / Q000737:chemistry; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D004339:Drug Compounding; D004344:Drug Incompatibility; D004355:Drug Stability; D006493:Heparin / Q000008:administration & dosage* / Q000737:chemistry; D006801:Humans; D013997:Time Factors
chemical_list: D000890:Anti-Infective Agents; D000925:Anticoagulants; D006493:Heparin