1. J Antimicrob Chemother. 2013 May;68(5):1179-82. doi: 10.1093/jac/dks510. Epub
2013 Jan 9.

Stability and compatibility of vancomycin for administration by continuous

Raverdy V, Ampe E, Hecq JD, Tulkens PM.

Pharmacologie cellulaire et moléculaire et Centre de pharmacie clinique, Louvain 
Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.

BACKGROUND: 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.
METHODS: 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.
RESULTS: 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
CONCLUSIONS: 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.

PMID: 23302579  [PubMed - in process]