J Nicholas O'Donnell1, Natarajan Venkatesan2, Malav Manek3, Nathaniel J Rhodes1, Marc H Scheetz4. 1. Department of Pharmacy Practice, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, and Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL. 2. Department of Pharmaceutical Science, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL. 3. Chicago College of Pharmacy, Midwestern University, Downers Grove, IL. 4. Department of Pharmacy Practice, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, and Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL. mscheetz@nm.org.
Abstract
PURPOSE: The compatibility of vancomycin and piperacillin-tazobactam in concentrations typically used in extended-infusion dosing schemes was evaluated. METHODS: Piperacillin-tazobactam was reconstituted and diluted to concentrations of 33.75, 45, 50, 60, 67.5, 80, and 90 mg/mL. Vancomycin was diluted to concentrations of 4-8, 10, and 12 mg/mL. The resultant admixtures were visually observed after preparation against black and white backgrounds each hour between hours 1 through 4 and after 24 hours. Frozen products of each medication and brand-name Zosyn powder for reconstitution also were studied. Each combination of products and concentrations was tested for precipitation using simulated Y-site administration. Absorbance and microscopic analyses were performed to discern less perceptible incompatibilities in combinations that did not result in visual precipitation. Changes in absorbance were evaluated using two-way repeated-measures analysis of variance with post hoc Bonferroni corrections. RESULTS: No tested concentrations of piperacillin-tazobactam showed precipitations with vancomycin up to concentrations of 7 mg/mL. Piperacillin-tazobactam 80-90 mg/mL formed reversible precipitation with vancomycin 8 mg/mL. All tested concentrations of piperacillin-tazobactam formed a reversible precipitate with vancomycin 10 mg/mL. Irreversible precipitation was noted with all combinations of piperacillin-tazobactam and vancomycin 12 mg/mL. No significant changes in absorbance analyses were identified for all tested piperacillin-tazobactam concentrations and vancomycin 4-10 mg/mL compared with 0.9% sodium chloride injection (p > 0.05). Similar results were observed using frozen preparations and brand-name Zosyn. CONCLUSION: Visual, microscopic, and absorbance analyses showed no evidence of incompatibility when piperacillin-tazobactam 33.75-90 mg/mL was combined with vancomycin ≤7 mg/mL. Reversible and irreversible precipitates formed when piperacillin-tazobactam was combined with vancomycin ≥8 mg/mL.
PURPOSE: The compatibility of vancomycin and piperacillin-tazobactam in concentrations typically used in extended-infusion dosing schemes was evaluated. METHODS:Piperacillin-tazobactam was reconstituted and diluted to concentrations of 33.75, 45, 50, 60, 67.5, 80, and 90 mg/mL. Vancomycin was diluted to concentrations of 4-8, 10, and 12 mg/mL. The resultant admixtures were visually observed after preparation against black and white backgrounds each hour between hours 1 through 4 and after 24 hours. Frozen products of each medication and brand-name Zosyn powder for reconstitution also were studied. Each combination of products and concentrations was tested for precipitation using simulated Y-site administration. Absorbance and microscopic analyses were performed to discern less perceptible incompatibilities in combinations that did not result in visual precipitation. Changes in absorbance were evaluated using two-way repeated-measures analysis of variance with post hoc Bonferroni corrections. RESULTS: No tested concentrations of piperacillin-tazobactam showed precipitations with vancomycin up to concentrations of 7 mg/mL. Piperacillin-tazobactam 80-90 mg/mL formed reversible precipitation with vancomycin 8 mg/mL. All tested concentrations of piperacillin-tazobactam formed a reversible precipitate with vancomycin 10 mg/mL. Irreversible precipitation was noted with all combinations of piperacillin-tazobactam and vancomycin 12 mg/mL. No significant changes in absorbance analyses were identified for all tested piperacillin-tazobactam concentrations and vancomycin 4-10 mg/mL compared with 0.9% sodium chloride injection (p > 0.05). Similar results were observed using frozen preparations and brand-name Zosyn. CONCLUSION:Visual, microscopic, and absorbance analyses showed no evidence of incompatibility when piperacillin-tazobactam 33.75-90 mg/mL was combined with vancomycin ≤7 mg/mL. Reversible and irreversible precipitates formed when piperacillin-tazobactam was combined with vancomycin ≥8 mg/mL.
Authors: Jack Chang; Gwendolyn M Pais; Kimberly Valdez; Sylwia Marianski; Erin F Barreto; Marc H Scheetz Journal: Antimicrob Agents Chemother Date: 2022-01-10 Impact factor: 5.938