Pharmacologie cellulaire et moléculaire et Centre de pharmacie clinique, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.
J Antimicrob Chemother. 2013 May;68(5):1179-82. doi: 10.1093/jac/dks510. Epub 2013 Jan 9.
Vancomycin is increasingly used by continuous infusion, but few specific data are available about stability under practical conditions of preparation and use, and compatibility with other intravenous drugs commonly used in the routine hospital setting.
Vancomycin stability [defined as recovery ≥ 93% of the original content (validated HPLC assay)] was examined throughout the whole process of centralized preparation, storage and use in the ward by infusion for up to 48 h, with allowances for deviations from recommended practice [exposure to high temperature; use of concentrated solutions (up to 83 g/L)]. Compatibility was assessed by mimicking co-administration in a single line via Y-shaped connectors with contact of 1 h at 25°C, followed by visual inspection (professional viewer), detection of particulate matter (particle analyser) and HPLC assay of vancomycin.
Vancomycin was stable during the whole process and also during 72 h exposure of concentrated solutions at temperatures up to 37°C. Major incompatibilities were seen with β-lactams (temocillin, piperacillin/tazobactam, ceftazidime, imipenem, cefepime and flucloxacillin) and moxifloxacin, but not with ciprofloxacin, aminoglycosides and macrolides. Propofol, valproic acid, phenytoin, theophylline, methylprednisolone and furosemide were also incompatible, whereas ketamine, sufentanil, midazolam, morphine, piritramide, nicardipine, urapidil, dopamine, dobutamine and adrenaline were compatible. No effect or incompatibility with N-acetyl-cysteine or amino acid solutions was detected.
Centralized preparation of vancomycin and its use by continuous infusion in wards is safe concerning stability, but careful attention must be paid to incompatibilities. Several drugs (including all β-lactams) require distinct intravenous lines or appropriate procedures to avoid undue contact.
万古霉素越来越多地通过连续输注使用，但关于在实际制备和使用条件下的稳定性以及与常规医院环境中常用的其他静脉药物的相容性方面，几乎没有具体的数据。
通过在病房中通过输注长达 48 小时的方式，对集中制备、储存和使用过程中的万古霉素稳定性（定义为恢复原始含量的≥93%（经验证的 HPLC 测定））进行了检查，并允许偏离推荐的实践[暴露于高温；使用浓缩溶液（高达 83g/L）]。通过在 25°C 下通过 Y 形连接器以 1 小时的接触时间模拟联合给药，并通过目视检查（专业观察者）、检测颗粒物（颗粒分析仪）和 HPLC 测定万古霉素来评估相容性。
万古霉素在整个过程中以及在高达 37°C 的浓缩溶液暴露 72 小时期间都是稳定的。与β-内酰胺类药物（替莫西林、哌拉西林/他唑巴坦、头孢他啶、亚胺培南、头孢吡肟和氟氯西林）和莫西沙星存在主要不相容性，但与环丙沙星、氨基糖苷类和大环内酯类药物没有不相容性。丙泊酚、丙戊酸钠、苯妥英、茶碱、甲泼尼龙和呋塞米也不相容，而氯胺酮、舒芬太尼、咪达唑仑、吗啡、哌替啶、尼卡地平、乌拉地尔、多巴胺、多巴酚丁胺和肾上腺素则相容。未检测到与 N-乙酰半胱氨酸或氨基酸溶液的相互作用或不相容性。
集中制备万古霉素并在病房中通过连续输注使用在稳定性方面是安全的，但必须密切注意不相容性。一些药物（包括所有β-内酰胺类药物）需要使用不同的静脉输液管路或适当的程序来避免不必要的接触。
