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- Title
Stability and compatibility of antimicrobial lock solutions.
- Authors
BOOKSTAVER, P. BRANDON; ROKAS, KRISTINA E. E.; NORRIS, LeANN B.; EDWARDS, JULIE M.; SHERERTZ, ROBERT J.
- Abstract
Purpose. Published stability and compatibility data on a growing array of solutions used for antimicrobial lock therapy (ALT) are reviewed. Summary. ALT involves the instillation of a highly concentrated antimicrobial, often in combination with an anticoagulant, into a central venous catheter (CVC) lumen; this technique is often used for prophylaxis after CVC insertion or as an adjunctive treatment in cases of central line-associated bloodstream infection (CLABSI) if catheter removal is not feasible. Optimal selection of stable and compatible antimicrobials and additives can maximize catheter dwell times, streamline pharmacy compounding practices, and help ensure patient safety. Of 98 articles on ALT solutions identified in a literature search, 17 met the prespecified criteria for the use of validated stability and compatibility methodology. Antimicrobials active against common CLABSI pathogens that may be appropriate for ALT include cefazolin, cefotaxime, ceftazidime, ciprofloxacin, daptomycin, gentamicin, linezolid, telavancin, ticarcillin-clavulanic acid, and vancomycin; validated data demonstrate the stability of these agents in solution with heparin or nonheparin anticoagulants over 72-96 hours or longer. Other antifungal agents and antiinfectives (e.g., ethyl alcohol) have been used in specific patients and ALT situations. The prolonged stability of several antimicrobial-additive combinations may allow for extended dwell times and less frequent lock solution exchanges. Conclusion. Pharmacists' knowledge of diverse combinations of antimicrobial agents and additives in lock solutions, including several shown to be stable and compatible for extended periods, can help expand and optimize the use of ALT in both treatment and prophylactic modalities.
- Subjects
ANTI-infective agents; ANTIBIOTICS; MEDLINE; SYSTEMATIC reviews; CENTRAL venous catheters; ANTIBIOTIC prophylaxis
- Publication
American Journal of Health-System Pharmacy, 2013, Vol 70, Issue 24, p2185
- ISSN
1079-2082
- Publication type
Article
- DOI
10.2146/ajhp120119