Stability of ceftriaxone sodium in peritoneal dialysis solutions

Continuous ambulatory peritoneal dialysis is used commonly in patients with endstage renal disease. Infection is the most frequent complication of this dialysis. To treat certain infections caused by gram-negative microorganisms, ceftriaxone sodium may be added to the peritoneal dialysate fluid. No data are available, however, about ceftriaxone's stability at various temperatures in dialysate solutions containing dextrose 1.5 and 4.25%. The objective of this study was to determine the stability of ceftriaxone in dialysis solutions containing dextrose 1.5 and 4.25% over 14 days at 4 degrees C, 5 days at 23 degrees C, and 24 hours at 37 degrees C. Ceftriaxone 500 mg was added to 36 dialysate bags (500 mL); six bags of each of two dextrose concentrations were stored at each of the three temperatures. The samples were collected at 0, 3, 7, 10, and 14 days at 4 degrees C; 0, 1, 2, and 5 days at 23 degrees C; and 0, 6, 12, and 24 hours at 37 degrees C. Ceftriaxone was measured by a specific, stability-indicating HPLC method. A clinically significant loss of potency was defined as a greater than ten percent decrease from its initial concentration. The mean ceftriaxone concentration was 90 percent or more of the initial concentration for 14 days at 4 degrees C, 24 hours at 23 degrees C, and 6 hours at 37 degrees C. Thus, ceftriaxone can be stored in dialysate solutions for 14 days under refrigeration, 24 hours at room temperature, and 6 hours at body temperature.