Mendes, K and Harmanjeet, H and Sedeeq, M and Modi, A and Wanandy, T and Zaidi, STR and Ming, LC and Castelino, RL and Sud, K and Peterson, GM and Patel, RP, Stability of meropenem and piperacillin/tazobactam with heparin in various peritoneal dialysis solutions, Peritoneal Dialysis International, 38, (6) pp. 430-440. ISSN 0896-8608 (2018) [Refereed Article]
Copyright 2018 International Society for Peritoneal Dialysis
Background: Infections caused by ceftazidime-resistant Pseudomonas and extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacteria are increasing worldwide. Meropenem and piperacillin/tazobactam (PIP/TZB) are recommended for the treatment of peritoneal dialysis-associated peritonitis (PDAP) caused by ceftazidime-resistant Pseudomonas and other resistant gram-negative bacteria. Patients may also receive intraperitoneal heparin to prevent occlusion of their catheters. However, the stability of meropenem or PIP/TZB, in combination with heparin, in different types of peritoneal dialysis (PD) solutions used in clinical practice is currently unknown. Therefore, we investigated the stability of meropenem and PIP/TZB, each in combination with heparin, in different PD solutions.
Methods: A total of 15 PD bags (3 bags for each type of PD solution) containing meropenem and heparin and 24 PD bags (3 bags for each type of PD solution) containing PIP/TZB and heparin were prepared and stored at 4°C for 168 hours. The same bags were stored at 25°C for 3 hours followed by 10 hours at 37°C. An aliquot withdrawn before storage and at defined time points was analyzed for the concentration of meropenem, PIP, TZB, and heparin using high-performance liquid chromatography. Samples were also analysed for particle content, pH and color change, and the anticoagulant activity of heparin.
Results: Meropenem and heparin retained more than 90% of their initial concentration in 4 out of 5 types of PD solutions when stored at 4°C for 168 hours, followed by storage at 25°C for 3 hours and then at 37°C for 10 hours. Piperacillin/tazobactam and heparin were found to be stable in all 8 types of PD solutions when stored under the same conditions. Heparin retained more than 98% of its initial anticoagulant activity throughout the study period. No evidence of particle formation, color change, or pH change was observed at any time under the storage conditions employed in the study.
Conclusions: This study provides clinically important information on the stability of meropenem and PIP/TZB, each in combination with heparin, in different PD solutions. The use of meropenem-heparin admixed in pH-neutral PD solutions for the treatment of PDAP should be avoided, given the observed sub-optimal stability of meropenem.
|Item Type:||Refereed Article|
|Keywords:||antibiotics, storage, anticoagulant, high performance liquid chromatography|
|Research Division:||Medical and Health Sciences|
|Research Group:||Pharmacology and Pharmaceutical Sciences|
|Research Field:||Clinical Pharmacology and Therapeutics|
|Objective Division:||Expanding Knowledge|
|Objective Group:||Expanding Knowledge|
|Objective Field:||Expanding Knowledge in the Medical and Health Sciences|
|UTAS Author:||Harmanjeet, H (Mr Harmanjeet Harmanjeet)|
|UTAS Author:||Sedeeq, M (Mr Mohammed Sedeeq)|
|UTAS Author:||Wanandy, T (Mr Troy Wanandy)|
|UTAS Author:||Zaidi, STR (Dr Tabish Razi Zaidi)|
|UTAS Author:||Ming, LC (Dr Long Ming)|
|UTAS Author:||Castelino, RL (Dr Ronald Castelino)|
|UTAS Author:||Peterson, GM (Professor Gregory Peterson)|
|UTAS Author:||Patel, RP (Dr Rahul Patel)|
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