Vancomycin and daptomycin stability in heparin or sodium citrate lock solutions
Por:
Bodega-Azuara, J, Belles-Medall, M, Edo-Penarrocha, J, Ferrando-Piqueres, R, Perez-Alba, A and Reque-Santivanez, J
Ahead of Print:
1 sep 2021
Resumen:
Background: We investigated physical and chemical stability of daptomycin and vancomycin in heparin or sodium citrate lock solutions. The aim of this study was to find the optimal combination of antimicrobials and additives for lock solutions, which maximized patient safety. Methods: Vancomycin and daptomycin were diluted with heparin or sodium citrate to achieve final concentrations of vancomycin-heparin 2.5 mg/mL-833.33 U/mL, vancomycin-citrate 2.5-33.3 mg/mL, daptomycin-heparin 5 mg/mL-800 U/mL, and daptomycin-citrate 5-32 mg/mL and they were stored at room temperature (+25 degrees C), 4 degrees C, -20 degrees C, and 37 degrees C. Physical and chemical stability were analyzed for each antibiotic-anticoagulant combination in all conditions immediately after preparation, at 24, 48, 72 h and at different time points until unstable concentrations were obtained. Daptomycin-sodium citrate microbiological activity was also studied by evaluating two Staphylococcus aureus cultures in a calcium enriched medium with a daptomycin E test, with and without sodium citrate. Results: After incubation at 37 degrees C vancomycin and daptomycin combined with heparin retained at least 90% of the initial concentration over 48 h. Vancomycin-sodium citrate solution stored at 37 degrees C reduced more than 10% of the initial concentration at 24 h. On the other hand, daptomycin-sodium citrate preparation was stable at 37 degrees C for 72 h but the microbiological activity of daptomycin was lower in the presence of sodium citrate. Conclusions: The purpose is to prepare vancomycin and daptomycin lock solutions combined with heparin. They should be changed at 48 h and its stability is over 3 days at 25 degrees C and 7 days at 4 degrees C, which allow Hospital Pharmacy Services to manage their stocks. Daptomycin-sodium citrate combination is more stable for extended periods but its bioactivity has not been demonstrated.
Filiaciones:
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Hosp Gen Univ Castellon, Hosp Pharm Serv, Avda Benicassim S-N, Castellon De La Plana 12004, Spain
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Hosp Gen Univ Castellon, Hosp Pharm Serv, Avda Benicassim S-N, Castellon De La Plana 12004, Spain
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Hosp Gen Univ Castellon, Hosp Pharm Serv, Avda Benicassim S-N, Castellon De La Plana 12004, Spain
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Hosp Gen Univ Castellon, Hosp Pharm Serv, Avda Benicassim S-N, Castellon De La Plana 12004, Spain
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Hosp Gen Univ Castellon, Serv Nephrol, Castellon De La Plana, Spain
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Hosp Gen Univ Castellon, Serv Nephrol, Castellon De La Plana, Spain
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