Résumé
Background and objectives: 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.
Methods: 7.5% icodextrin PD-bags were dosed with gentamicin 20 mg/L (n = 9), vancomycin 1,000 mg/L (n = 9), cefazolin 500mg/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 degrees C, room-temperature (25 degrees C), and refrigeration (4 degrees 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.
Results: Gentamicin was stable for 14 days at all temperatures. Vancomycin was stable for 4 days at 37 degrees C and for 14 days at both 25 degrees C and 4 degrees C. The gentamicin and vancomycin combination was stable for 4 days at 37 degrees C and for 14 days at 25 degrees C and 4 degrees C. Cefazolin alone was stable for 24 hours at 37 degrees C, 7 days at 25 degrees C, and 14 days at 4 degrees C. Ceftazidime alone was stable for only 6 hours at 37 degrees C, 2days at 25 degrees C, and 14 days at 4 degrees C. The cefazolin and ceftazidime combination was stable for 24 hours at 37 degrees C, 2 days at 25 degrees C, and 14days at 4 degrees C. The cefazolin and gentamicin combination was stable for 1 day at 37 degrees C, 4 days at 25 degrees C, and 14 days at 4 degrees C.
Conclusions: Antibiotics premixed in icodextrin PD-bags have varying stabilities with stability generally least at 37 degrees C and best at 4 degrees C, permitting storage for 14 days when refrigerated and pre-warming to body temperature prior to administration. Further research confirming the sterility of these antibiotic-containing bags is recommended.