Surendra Kandel1, Syed Tabish R Zaidi1, S Troy Wanandy1,2, Long C Ming1,3, Ronald L Castelino4,5, Kamal Sud5,6, Rahul P Patel7. 1. Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia. 2. Department of Pharmacy, Royal Hobart Hospital, Hobart, Tasmania, Australia. 3. School of Pharmacy, KPJ Healthcare University College, Nilai, Negeri Sembilan, Malaysia. 4. School of Nursing, University of Sydney, New South Wales, Australia. 5. Peritoneal Dialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Blacktown, New South Wales, Australia. 6. Department of Renal Medicine, Nepean Hospital and Nepean Clinical School, University of Sydney, Kingswood, New South Wales, Australia. 7. Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia Rahul.Patel@utas.edu.au.
Abstract
BACKGROUND: Intraperitoneal (IP) administration of ceftazidime is recommended for the treatment of peritoneal dialysis-associated peritonitis (PDAP) from Pseudomonas. Patients with PDAP may also need IP heparin to overcome problems with drainage of turbid peritoneal dialysis (PD) fluids and blockage of catheters with fibrin. Physico-chemical stability of ceftazidime and heparin, and biological stability of heparin in many types of PD solutions is unknown. Therefore, we investigated the stability of ceftazidime and heparin in 4 types of PD solutions. METHODS: A total of 12 PD bags (3 for each type of solution) containing ceftazidime and heparin were prepared and stored at 4°C for 120 hours, and then at 25°C for 6 hours, and finally at 37°C for 12 hours. An aliquot was withdrawn after predefined time points and analyzed for the concentration of ceftazidime and heparin using high-performance liquid-chromatography (HPLC). Samples were assessed for pH, color changes, particle content, and anticoagulant activity of heparin. RESULTS: Ceftazidime and heparin retained more than 91% of their initial concentration when stored at 4°C for 120 hours followed by storage at 25°C for 6 hours and then at 37°C for 12 hours. Heparin retained more than 95% of its initial activity throughout the study period. Particle formation was not detected at any time under the storage conditions. The pH and color remained essentially unchanged throughout the study. CONCLUSIONS: Ceftazidime-heparin admixture retains its stability over long periods of storage at different temperatures, allowing its potential use for PDAP treatment in outpatient and remote settings.
BACKGROUND: Intraperitoneal (IP) administration of ceftazidime is recommended for the treatment of peritoneal dialysis-associated peritonitis (PDAP) from Pseudomonas. Patients with PDAP may also need IP heparin to overcome problems with drainage of turbid peritoneal dialysis (PD) fluids and blockage of catheters with fibrin. Physico-chemical stability of ceftazidime and heparin, and biological stability of heparin in many types of PD solutions is unknown. Therefore, we investigated the stability of ceftazidime and heparin in 4 types of PD solutions. METHODS: A total of 12 PD bags (3 for each type of solution) containing ceftazidime and heparin were prepared and stored at 4°C for 120 hours, and then at 25°C for 6 hours, and finally at 37°C for 12 hours. An aliquot was withdrawn after predefined time points and analyzed for the concentration of ceftazidime and heparin using high-performance liquid-chromatography (HPLC). Samples were assessed for pH, color changes, particle content, and anticoagulant activity of heparin. RESULTS:Ceftazidime and heparin retained more than 91% of their initial concentration when stored at 4°C for 120 hours followed by storage at 25°C for 6 hours and then at 37°C for 12 hours. Heparin retained more than 95% of its initial activity throughout the study period. Particle formation was not detected at any time under the storage conditions. The pH and color remained essentially unchanged throughout the study. CONCLUSIONS:Ceftazidime-heparin admixture retains its stability over long periods of storage at different temperatures, allowing its potential use for PDAP treatment in outpatient and remote settings.
Authors: Simon Wai Yin So; Lu Chen; Alex Yuk Hei Woo; Derek Man Him Ng; Jennifer Ka Wah Wong; Kai Ming Chow; Naomi Runnegar; David W Johnson; Philip Kam-Tao Li Journal: Clin Kidney J Date: 2022-01-17