title: Physical compatibility of ceftolozane-tazobactam with selected i.v. drugs during simulated Y-site administration.
abstract: OBJECTIVE
  Results of a study to examine the physical compatibility of ceftolozane-tazobactam with common i.v. medications during simulated Y-site administration are presented.
  
  
  METHODS
  Ceftolozane-tazobactam was reconstituted according to manufacturer recommendations and diluted with 0.9% sodium chloride or 5% dextrose to solutions containing 15 mg (10 mg of ceftolozane and 5 mg of tazobactam)/mL. All other i.v. drugs were prepared according to manufacturer recommendations and diluted with 0.9% sodium chloride or 5% dextrose to standard concentrations used clinically. Y-site administration was simulated by mixing ceftolozane-tazobactam solution with each tested drug solution at a 1:1 ratio. Solutions were inspected for visual, turbidity, and pH changes immediately and 15, 60, and 120 minutes after mixing. Incompatibility was defined as precipitation, color change, a positive Tyndall test, a change in turbidity of ≥0.5 nephelometric turbidity unit, or a change in pH of ≥1 unit during the 120-minute observation period.
  
  
  RESULTS
  Of the 95 i.v. drugs tested, ceftolozane-tazobactam was compatible with 86 drugs in both diluents; notably, it was compatible with metronidazole in both solutions. No substantial pH changes were observed in any tested combination. Ceftolozane-tazobactam was incompatible with albumin, amphotericin B, caspofungin, cyclosporine, nicardipine, and phenytoin sodium due to turbidity changes and with propofol due to formation of an oily layer.
  
  
  CONCLUSIONS
  Ceftolozane-tazobactam 15 mg (10 mg of ceftolozane and 5 mg of tazobactam)/mL was physically compatible with 86 of 95 study drugs tested in both 0.9% sodium chloride injection and 5% dextrose injection during simulated Y-site administration.
authors.affiliation: Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT.|Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Abrar K
authors.initials: AK
authors.lastname: Thabit
authors.affiliation: Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT.|Aichi Medical University Hospital School of Medicine, Aichi, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Hamada
authors.affiliation: Center for Anti-Infective Research and Development and Division of Infectious Diseases, Hartford Hospital, Hartford, CT. david.nicolau@hhchealth.org.
authors.forename: David P
authors.initials: DP
authors.lastname: Nicolau
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000737:chemistry*; D002511:Cephalosporins / Q000008:administration & dosage / Q000737:chemistry*; D002626:Chemistry, Pharmaceutical; D004344:Drug Incompatibility; D005079:Excipients / Q000737:chemistry; D005947:Glucose / Q000737:chemistry; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D007275:Injections, Intravenous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D009391:Nephelometry and Turbidimetry; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000737:chemistry; D012965:Sodium Chloride / Q000737:chemistry; D012995:Solubility; D000078142:Tazobactam; D014552:Urinary Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D005079:Excipients; C000594038:ceftolozane, tazobactam drug combination; D012965:Sodium Chloride; D010397:Penicillanic Acid; D005947:Glucose; D000078142:Tazobactam
keywords: antibiotic; ceftolozane–tazobactam; compatibility; infection; intravenous; pH