Total intended antibiotic delivery related to drug concentration affecting the flow rate of elastomeric devices used in outpatient parenteral antimicrobial therapy (OPAT)

Perks, Stephen J., Pain, Tilley, and Franklin, Richard (2019) Total intended antibiotic delivery related to drug concentration affecting the flow rate of elastomeric devices used in outpatient parenteral antimicrobial therapy (OPAT). Journal of Pharmacy Practice and Research, 49 (4). pp. 349-355.

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Abstract

Background: Many studies have investigated drug stability in extended home infusion pumps, but little is known of other factors that may affect the total daily dose the patient receives. It has been noted that up to 40% of these infusions are incomplete after the designated run out time. Aim: This study investigated whether concentration can affect the flow rate of home infusion pumps, and thus the total dose the patient receives in outpatient parenteral antimicrobial therapy (OPAT). Method: The flow rates of 10 different drug and dose formulations (4–18 g in 0.9% sodium chloride) in Baxter LV10 (Old Toongabbie, Australia) infusion pumps were investigated. The pumps were run out at 31°C and weighed at intervals, with flow rate and total volume infused calculated over the 24-h period. Results: Piperacillin/tazobactam 18 g was the only formulation not to meet the minimum standard of 90% of the volume being infused over the 24-h period. This indicates a failure of intended therapy. Across all infusions, the expected dose delivered (DD) can be calculated as %DD = −1.9x + 122.85, where x is the total drug and excipient weight within the infusor. Conclusion: Dose is inversely related to flow rate in the LV10 Baxter infusion pump. Under nominal conditions, any amount greater than 12.02 g in the 240-mL infusion pump will result in an incomplete run out over the 24-h period. Clinicians should be aware that prescribing daily doses higher than 17.28 g may result in <90% of the intended dose being received by the patient. Further research should investigate whether this decrease in flow rate results in poor clinical outcomes.

Item ID: 61942
Item Type: Article (Research - C1)
ISSN: 2055-2335
Keywords: adverse outcomes, antibiotic administration, hospital in the home, infusion pumps, outpatient parenteral antimicrobial therapy, viscosity
Copyright Information: © 2019 The Society of Hospital Pharmacists of Australia
Date Deposited: 05 Feb 2020 02:35
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1115 Pharmacology and Pharmaceutical Sciences > 111503 Clinical Pharmacy and Pharmacy Practice @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920199 Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified @ 100%
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