Stability of Antibiotics for Intraperitoneal Administration in Extraneal 7.5% Icodextrin Peritoneal Dialysis Bags (STAB Study).
♦



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. ♦



7.5% icodextrin PD-bags were dosed with gentamicin 20 mg/L (n = 9), vancomycin 1,000 mg/L (n = 9), cefazolin 500 mg/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. ♦



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, 2 days 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 14 days 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. ♦



Antibiotics premixed in icodextrin PD-bags have varying stabilities with stability generally least at 37°C and best at 4(o)C, permitting storage for 14 days when refrigerated and prewarming to body temperature prior to administration. Further research confirming the sterility of these antibiotic-containing bags is recommended.
Department of Renal Medicine, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia dwarakanathan.ranganathan@health.qld.gov.au.
Dwarakanathan
D
Ranganathan
Burns, Trauma & Critical Care Research Centre, The University of Queensland, Herston, Brisbane, Queensland, Australia.
Saiyuri
S
Naicker
Burns, Trauma & Critical Care Research Centre, The University of Queensland, Herston, Brisbane, Queensland, Australia.
Steven C
SC
Wallis
Burns, Trauma & Critical Care Research Centre, The University of Queensland, Herston, Brisbane, Queensland, Australia Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia.
Jeffrey
J
Lipman
Department of Renal Medicine, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia.
Sharad K
SK
Ratanjee
Burns, Trauma & Critical Care Research Centre, The University of Queensland, Herston, Brisbane, Queensland, Australia Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia.
Jason A
JA
Roberts
D000900:Anti-Bacterial Agents / Q000737:chemistry*; D002437:Cefazolin; D002442:Ceftazidime; D015314:Dialysis Solutions / Q000737:chemistry*; D004355:Drug Stability; D004356:Drug Storage; D005839:Gentamicins; D005936:Glucans / Q000737:chemistry*; D005947:Glucose / Q000737:chemistry*; D006801:Humans; D000077607:Icodextrin; D010530:Peritoneal Dialysis; D013696:Temperature; D014640:Vancomycin
D000900:Anti-Bacterial Agents; D015314:Dialysis Solutions; D005839:Gentamicins; D005936:Glucans; D000077607:Icodextrin; D014640:Vancomycin; D002442:Ceftazidime; D002437:Cefazolin; D005947:Glucose
Cefazolin; ceftazidime; gentamicin; peritonitis; stability; vancomycin