Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb 22;10(2):217.
doi: 10.3390/antibiotics10020217.

Toward Safe Pharmacotherapy: The Interplay between Meropenem and Parenteral Nutrition Admixtures

Aleksandra Gostyńska  1 , Ludwika Piwowarczyk  1 , Malwina Nadolna  1 , Anna Jelińska  1 , Katarzyna Dettlaff  1 , Magdalena Ogrodowczyk  1 , Maria Popielarz-Brzezińska  1 , Maciej Stawny  1
Affiliations

Toward Safe Pharmacotherapy: The Interplay between Meropenem and Parenteral Nutrition Admixtures

Aleksandra Gostyńska et al. Antibiotics (Basel). .

Abstract

Simultaneous administration of parenteral nutrition (PN) admixtures with intravenous antibiotics is a common clinical problem. Coadministration of drugs incompatible with PN admixture may affect its stability, especially in the context of lipid droplet size, which is a crucial parameter for patient safety. In the present study, we investigate the in vitro compatibility of meropenem (Meropenem 1000, MPM) with five commercial PN admixtures used worldwide: Kabiven, Olimel N9E, Nutriflex Lipid Special, Nutriflex Omega Special, and SmofKabiven. The appropriate volumetric ratios, reflecting their clinical practice ratios, were used to prepare the MPM-PN admixture samples. Physicochemical properties of MPM-PN admixtures samples were determined upon preparation and after four hours of storage. The pH changes for all MPM-PN admixtures samples did not exceed the assumed level of acceptability and ranged from 6.41 to 7.42. After four hours of storage, the osmolarity changes were ±3%, except MPM-Olimel N9E samples, for which differences from 7% to 11% were observed. The adopted level of acceptability of changes in zeta potential after four hours of storage (±3 mV) was met for MPM-Kabiven, MPM-Nutriflex Lipid Special, and MPM-Nutriflex Omega Special. The mean droplet diameter for all samples was below 500 nm. However, only in the case of Nutriflex Lipid Special and Nutriflex Omega Special, the addition of MPM did not cause the formation of the second fraction of lipid droplets. The coadministration of MPM via Y-site with Kabiven, Olimel N9E, and Smofkabiven should be avoided due to osmolarity fluctuations (MPM-Olimel), significant differences in zeta potential (MPM-Olimel, MPM-Smofkabiven), and the presence of the second fraction of lipid droplets >1000 nm (MPM-Kabiven, MPM-Olimel, and MPM-Smofkabiven). The assumed acceptance criteria for MPM compatibility of MPM with PN admixtures were met only for Nutriflex Lipid Special and Nutriflex Omega Special in 1:1, 2:1, and 4:1 volume ratios.

Keywords: Y-site administration; drug compatibility; meropenem; parenteral nutrition; safe pharmacotherapy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Summary of compatibility studies of MPM and parenteral nutrition admixtures.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Pinelli F., Cecero E., Degl’Innocenti D., Selmi V., Giua R., Villa G., Chelazzi C., Romagnoli S., Pittiruti M. Infection of totally implantable venous access devices: A review of the literature. J. Vasc. Access. 2018;19:230–242. doi: 10.1177/1129729818758999. - DOI - PubMed
    1. Kanji S., Lam J., Johanson C., Singh A., Goddard R., Fairbairn J., Lloyd T., Monsour D., Kakal J. Systematic review of physical and chemical compatibility of commonly used medications administered by continuous infusion in intensive care units. Crit. Care Med. 2010;38:1890–1898. doi: 10.1097/CCM.0b013e3181e8adcc. - DOI - PubMed
    1. Taxis K., Barber N. Ethnographic study of incidence and severity of intravenous drug errors. BMJ. 2003;326:684–687. doi: 10.1136/bmj.326.7391.684. - DOI - PMC - PubMed
    1. Bouchoud L., Fonzo-Christe C., Klingmüller M., Bonnabry P. Compatibility of intravenous medications with parenteral nutrition: In vitro evaluation. J. Parenter. Enteral Nutr. 2013;37:416–424. doi: 10.1177/0148607112464239. - DOI - PubMed
    1. Staven V., Iqbal H., Wang S., Grønlie I., Tho I. Physical compatibility of total parenteral nutrition and drugs in Y-site administration to children from neonates to adolescents. J. Pharm. Pharmacol. 2017;69:448–462. doi: 10.1111/jphp.12647. - DOI - PubMed

LinkOut - more resources