Ampicillin extended infusion

[rxlea]

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Enterococcus faecalis native valve endocarditis sensitive to ampicillin--

Renal dose reduction to 8g from 12g in NS over 24 hours. Pt's home health was administering the 12g in 500 ml NS over the 24. We questioned the stability of the infusion.. I was told by professors that although continuous infusion was optimal, the drug once diluted in the NS was only stable 8 hours so you have to split it up. At work, I suggested to split up the preparation while maintaining the continuous infusion. A pharmacist dug up a Spanish article from 2001 that said the drug was good 24 hours in 500ml NS. Another said it had to be 1% concentration.

What do you guys see at your institution? Do you do continuous infusion or q4-6? If continuous, do you run it over 24 hours or change out the bag q8?

There is a lot of contradiction out there it seems based on the sources I've seen.

We changed the order anyway but I'd like to know for the future.

I don't have home health experience so I'd also like to hear what those guys think.

Thanks in advance!

 

[Sparda29]

I don't think I've ever given out or seen a patient on ampicillin at my hospital. Unasyn yes, Ampicillin, no.

 

[Praziquantel86]

I recall seeing someone on a 24-hour infusion as a student. The home health company said it was stable, so we went with it.

 

[thephoenician88]

Enterococcus faecalis native valve endocarditis sensitive to ampicillin--

Renal dose reduction to 8g from 12g in NS over 24 hours. Pt's home health was administering the 12g in 500 ml NS over the 24. We questioned the stability of the infusion.. I was told by professors that although continuous infusion was optimal, the drug once diluted in the NS was only stable 8 hours so you have to split it up. At work, I suggested to split up the preparation while maintaining the continuous infusion. A pharmacist dug up a Spanish article from 2001 that said the drug was good 24 hours in 500ml NS. Another said it had to be 1% concentration.

What do you guys see at your institution? Do you do continuous infusion or q4-6? If continuous, do you run it over 24 hours or change out the bag q8?

There is a lot of contradiction out there it seems based on the sources I've seen.

We changed the order anyway but I'd like to know for the future.

I don't have home health experience so I'd also like to hear what those guys think.

Thanks in advance!

micromedex says it's variable, but basically you should expect a loss of effectiveness after 8 hours.

Here's a cool tip i read though,
Chemical Stability:Little or no ampicillin loss in 24 hours stored under refrigeration. About 9% loss in 6 hours and about 19 to 21% loss in 24 hours at 30 °C. The use of frozen gel packs in insulated packs to chill the ampicillin solution during simulated administration slowed the loss of ampicillin; losses of 3 to 7% occurred in 24 hours.

 

[VCU07]

Enterococcus faecalis native valve endocarditis sensitive to ampicillin--

Renal dose reduction to 8g from 12g in NS over 24 hours. Pt's home health was administering the 12g in 500 ml NS over the 24. We questioned the stability of the infusion.. I was told by professors that although continuous infusion was optimal, the drug once diluted in the NS was only stable 8 hours so you have to split it up. At work, I suggested to split up the preparation while maintaining the continuous infusion. A pharmacist dug up a Spanish article from 2001 that said the drug was good 24 hours in 500ml NS. Another said it had to be 1% concentration.

What do you guys see at your institution? Do you do continuous infusion or q4-6? If continuous, do you run it over 24 hours or change out the bag q8?

There is a lot of contradiction out there it seems based on the sources I've seen.

We changed the order anyway but I'd like to know for the future.

I don't have home health experience so I'd also like to hear what those guys think.

Thanks in advance!

We do 24hr infusions of Nafcillin.

 

[iFarm]

3 day stability in NS, refrigerated @ 10mg/ml.

 

[rxlea]

3 day stability in NS, refrigerated @ 10mg/ml.

What source are you using? As someone pointed out, we'd have to hang the bag with ice packs then.

 

[rxlea]

We do 24hr infusions of Nafcillin.

We do those for other indications.

This patient needed ampicillin.

 

[rxlea]

micromedex says it's variable, but basically you should expect a loss of effectiveness after 8 hours.

Here's a cool tip i read though,
Chemical Stability:Little or no ampicillin loss in 24 hours stored under refrigeration. About 9% loss in 6 hours and about 19 to 21% loss in 24 hours at 30 °C. The use of frozen gel packs in insulated packs to chill the ampicillin solution during simulated administration slowed the loss of ampicillin; losses of 3 to 7% occurred in 24 hours.

I always ask myself this question: if that was my mom up there, what would I do?

Seems like a lot of potential loss for someone with endocarditis. The nurses would have to remember the ice packs for one thing....but I suppose less than 10% is acceptable. And it is less work for nurses with multiple patients as well as less work for the IV room. Le sigh.

 

[iFarm]

What source are you using? As someone pointed out, we'd have to hang the bag with ice packs then.

Yes, ice packs. Not sure how that would work in the hospital, but with an ambulatory pump at home... patients usually use a pump pouch. You can store a couple of ice packs in there(on either side of the medication) and then switch them out as needed. We don't give it the full 7 days stated below (monitoring temperature and patient compliance w/ ice packs in the home would be difficult), but less than 4% loss @ 7 days is pretty solid.

From Trissel's 2 IV compatibility (thomson.com) -- Ampicillin losses were about 6% in 24 hours and 15% in 72 hours at 25 °C. Less than 4% loss occurred in 7 days at 5 °C.

 

[rxlea]

Yes, ice packs. Not sure how that would work in the hospital, but with an ambulatory pump at home... patients usually use a pump pouch. You can store a couple of ice packs in there(on either side of the medication) and then switch them out as needed. We don't give it the full 7 days stated below (monitoring temperature and patient compliance w/ ice packs in the home would be difficult), but less than 4% loss @ 7 days is pretty solid.

From Trissel's 2 IV compatibility (thomson.com) -- Ampicillin losses were about 6% in 24 hours and 15% in 72 hours at 25 °C. Less than 4% loss occurred in 7 days at 5 °C.

Thanks. Yeah, compliance on nursing's part was another main concern of mine.

Well, now I know for next time. Thanks guys!

 

[joetrisman]

Yes, ice packs. Not sure how that would work in the hospital, but with an ambulatory pump at home... patients usually use a pump pouch. You can store a couple of ice packs in there(on either side of the medication) and then switch them out as needed. We don't give it the full 7 days stated below (monitoring temperature and patient compliance w/ ice packs in the home would be difficult), but less than 4% loss @ 7 days is pretty solid.

From Trissel's 2 IV compatibility (thomson.com) -- Ampicillin losses were about 6% in 24 hours and 15% in 72 hours at 25 °C. Less than 4% loss occurred in 7 days at 5 °C.

I always ask myself this question: if that was my mom up there, what would I do?

Seems like a lot of potential loss for someone with endocarditis. The nurses would have to remember the ice packs for one thing....but I suppose less than 10% is acceptable. And it is less work for nurses with multiple patients as well as less work for the IV room. Le sigh.

Thanks. Yeah, compliance on nursing's part was another main concern of mine.

Well, now I know for next time. Thanks guys!

I'm now going to invent a kegerator type device for abx. I'll be RICH!!!!

 

[xiphoid2010]

Have to chime in from a management point of view. I don't deal with outpatient infusions and we don't do continuous amp infusion here. But if I can't find the room temp stability data for longer than 8 hrs in a major source, eg trissels or PI, I would be thinking about what kind of liability it might produce for the pharmacy. And if the same source provides conflicting stability info, i would go with the shortest at the given concentration. Just me, I personally would rather error on the side of caution.

 

[aboveliquidice]

Have to chime in from a management point of view. I don't deal with outpatient infusions and we don't do continuous amp infusion here. But if I can't find the room temp stability data for longer than 8 hrs in a major source, eg trissels or PI, I would be thinking about what kind of liability it might produce for the pharmacy. And if the same source provides conflicting stability info, i would go with the shortest at the given concentration. Just me, I personally would rather error on the side of caution.

This... If it is well studied... its in reputable tertiary sources. Outside of research, I would stay on the side of caution.