Extended duration infusion temperatures in the tropics: 2 (EDITT2)

Perks, Stephen J., Robinson, Niecole, Pain, Tilley, and Franklin, Richard (2018) Extended duration infusion temperatures in the tropics: 2 (EDITT2). Journal of Pharmacy Practice and Research, 48 (5). pp. 423-430.

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Abstract

Background:

Stability data tested at 25°C may not be suitable for use in the tropics in the home intravenous infusions (Home‐IV) setting. A 24‐h solution temperature profile is needed to investigate medication stability in this setting.

Aim:

This study investigated and mapped the solution temperature within the Baxter LV10 elastomeric infusor device in a tropical environment over a 24‐h period.

Methods:

Volunteer patients from Home‐IV clinics in two tropical Australian cities wore elastomeric infusor devices for 24 h over the summer months. Temperature devices were inserted into the solution to directly log solution temperature.

Results:

Solution temperature was >25°C 79.8% of the time. Mean time to inflection (temperature stops rising and begins fluctuating) was 9.4 h (95% confidence interval (CI) 8.6–10.2), with a maximum inflection point of 14.5 h. The mean (95% CI) temperature at inflection and after inflection was 30.6°C (29.8–31.5) and 29.5°C (29.3–29.6), respectively; the 90th percentile temperature after inflection was 32.5°C. Analysis of variance revealed a significant difference of 3.1°C between air‐conditioned and non‐air‐conditioned data (F1,28 = 13.06, p = 0.001). The 90th percentile temperature after inflection for non‐air‐conditioned data was 33.1°C.

Conclusions:

Stability studies performed at 25°C are inappropriate for tropical regions. Possible factors contributing to the higher temperatures include body and ambient room temperature. We recommend that medications are tested in 24‐h elastomeric infusor devices in three steps: (1) refrigerated for up to 7 days; (2) steady increase from refrigerated to 34°C over 9 h; and (3) maintained at 34°C for the remaining 15 h. This more accurately reflects the temperature profile experienced in warmer climates. Furthermore, Home‐IV patients should be encouraged to remain in an air‐conditioned environment, or at least indoors, over the summer months to decrease the potential for antibiotic degradation.

Item ID: 56533
Item Type: Article (Research - C1)
ISSN: 2055-2335
Keywords: antibiotics, stability, temperature, tropics, home intravenous infusions (Home-IV)
Copyright Information: Copyright © 2018 The Society of Hospital Pharmacists of Australia
Funders: Human Research Ethics Committee of The Townsville Hospital Health Service
Projects and Grants: HREC/15/QTHS/193
Date Deposited: 07 Dec 2018 01:34
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1115 Pharmacology and Pharmaceutical Sciences > 111504 Pharmaceutical Sciences @ 100%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920204 Evaluation of Health Outcomes @ 100%
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