Physical compatibility of fosfomycin for injection with select i.v. drugs during simulated Y-site administration

Marguerite L. Monogue, Safa S. Almarzoky Abuhussain, Joseph L. Kuti, David P. Nicolau

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose. The results of a study to determine the physical compatibility of ZTI-01 (fosfomycin for injection) in 0.9% sodium chloride or 5% dextrose during simulated Y-site administration with 37 i.v. antimicrobials and 58 nonantimicrobials are reported. Methods. Fosfomycin, an epoxide antibiotic with broad-spectrum activity against multidrug-resistant bacteria, is marketed in the United States only in an oral formulation with limited bioavailability, but an i.v. formulation is in development. Fosfomycin for injection and other evaluated drugs were reconstituted according to manufacturer recommendations and further diluted with 0.9% sodium chloride or 5% dextrose to the final desired concentrations. Y-site administration was simulated in glass culture tubes. Incompatibility was defined as changes in visual characteristics or a change in turbidity of >0.5 nephelometric turbidity units over the 120-minute observation period. Results. Of the 95 drugs tested, 16 were incompatible with fosfomycin in 0.9% sodium chloride, and 18 were incompatible with fosfomycin in 5% dextrose; incompatibility was observed with 10 of 37 antimicrobials, including the 3 commercially available amphotericin B products, anidulafungin, caspofungin, ceftaroline, ciprofloxacin, daptomycin, doxycycline, and isavuconazonium sulfate. Conclusion. Fosfomycin for injection at a concentration of 30 mg/mL was physically compatible with 73 of 95 (77%) of the i.v. drugs tested at concentrations used clinically in both 0.9% sodium chloride injection and 5% dextrose injection. Twenty-two drugs were deemed incompatible in at least 1 of the 2 diluents.

Original languageEnglish (US)
Pages (from-to)e36-e44
JournalAmerican Journal of Health-System Pharmacy
Volume75
Issue number1
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

Fingerprint

Fosfomycin
Sodium Chloride
Injections
Pharmaceutical Preparations
Glucose
caspofungin
anidulafungin
Daptomycin
Doxycycline
Epoxy Compounds
Amphotericin B
Ciprofloxacin
Biological Availability
Glass
Observation
Anti-Bacterial Agents
Bacteria

Keywords

  • Antibiotics
  • Compatibility
  • Fosfomycin
  • Intravenous
  • ZTI-01

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy

Cite this

Physical compatibility of fosfomycin for injection with select i.v. drugs during simulated Y-site administration. / Monogue, Marguerite L.; Almarzoky Abuhussain, Safa S.; Kuti, Joseph L.; Nicolau, David P.

In: American Journal of Health-System Pharmacy, Vol. 75, No. 1, 01.01.2018, p. e36-e44.

Research output: Contribution to journalArticle

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abstract = "Purpose. The results of a study to determine the physical compatibility of ZTI-01 (fosfomycin for injection) in 0.9{\%} sodium chloride or 5{\%} dextrose during simulated Y-site administration with 37 i.v. antimicrobials and 58 nonantimicrobials are reported. Methods. Fosfomycin, an epoxide antibiotic with broad-spectrum activity against multidrug-resistant bacteria, is marketed in the United States only in an oral formulation with limited bioavailability, but an i.v. formulation is in development. Fosfomycin for injection and other evaluated drugs were reconstituted according to manufacturer recommendations and further diluted with 0.9{\%} sodium chloride or 5{\%} dextrose to the final desired concentrations. Y-site administration was simulated in glass culture tubes. Incompatibility was defined as changes in visual characteristics or a change in turbidity of >0.5 nephelometric turbidity units over the 120-minute observation period. Results. Of the 95 drugs tested, 16 were incompatible with fosfomycin in 0.9{\%} sodium chloride, and 18 were incompatible with fosfomycin in 5{\%} dextrose; incompatibility was observed with 10 of 37 antimicrobials, including the 3 commercially available amphotericin B products, anidulafungin, caspofungin, ceftaroline, ciprofloxacin, daptomycin, doxycycline, and isavuconazonium sulfate. Conclusion. Fosfomycin for injection at a concentration of 30 mg/mL was physically compatible with 73 of 95 (77{\%}) of the i.v. drugs tested at concentrations used clinically in both 0.9{\%} sodium chloride injection and 5{\%} dextrose injection. Twenty-two drugs were deemed incompatible in at least 1 of the 2 diluents.",
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