Compatibility of parenteral nutrient solutions of Ramathibodi Hospital with cephalosporins

Abstract

The hospitalized patients who required parenteral nutrition frequently need to receive parenteral medication as well. The use of combination of drugs and parenteral nutrient (PN) solution may be beneficial when there is limited venous access and/or the patient is fluid restricted. The purpose of this study was to determine the compatibility and stability of cephalosporins in solutions for total and peripheral parenteral nutrition, TPN and PPN, typically used in Ramathibodi Hospital. Each of cephalosporin solutions was combined with either TPN or PPN solutions at a volume ratio of 1:1. Determinations of physical incompatibility were performed by visual observation and measurement of degree of turbidity. Chemical incompatibility was determined by the measurement of pH. The stability of cephalosporins (cefazolin and ceftazidime) in PN solutions was measured by HPLC technique. The results of physical incompatibility studies indicated that cefazolin, cefoxitin, and ceftazidime were physically compatible with PNsolutions for 48 hours at room temperature. However, cefotaxime and ceftriazone in combination with PN solutions showed visible precipitate and haze in 48 and 12 hours, respectively. The pH values of all drugs combined with PN solutions were similar, and in the range of 6-7. The amount of cefazolin and ceftazidime obtained from analysis remained greater than 90% of the initial concentration at 24 and 8 hours, respectively. The findings might be use as the guidelines for patients who require the co-administration of cephalosporins and PN solutions through a Y-injection site in the adinistration set. Cefazolin, cefoxitin, and ceftazidime were suitable to be coadinistered with PN solutions. In contrast, cefotaxime and ceftriaxone should be administered through a separate line with PN solutions to avoid the potential for incompatibilities.