Stability and compatibility of antimicrobial lock solutions

Area of Science:

• Pharmacology
• Infectious Diseases
• Clinical Pharmacy

Background:

• Antimicrobial lock therapy (ALT) is crucial for managing central line-associated bloodstream infections (CLABSI) and for prophylaxis.
• Optimal selection of stable and compatible antimicrobial lock solutions is essential for maximizing catheter dwell times, streamlining pharmacy practices, and ensuring patient safety.

Purpose of the Study:

• To review published stability and compatibility data for antimicrobial solutions used in antimicrobial lock therapy (ALT).
• To identify antimicrobial agents and additives suitable for ALT based on validated stability and compatibility studies.

Main Methods:

• A literature search identified 98 articles on ALT solutions.
• Seventeen articles met prespecified criteria for validated stability and compatibility methodology.

Main Results:

• Validated data confirm the stability of common CLABSI antimicrobials (e.g., vancomycin, cefazolin, ciprofloxacin) with heparin or non-heparin anticoagulants for 72-96 hours or longer.
• Several antimicrobial-additive combinations exhibit prolonged stability, potentially allowing for extended dwell times and less frequent lock solution exchanges.
• Other agents like ethyl alcohol have specific ALT applications.

Conclusions:

• Pharmacists' understanding of stable and compatible antimicrobial-anticoagulant combinations for ALT can enhance its use in treatment and prophylaxis.
• Optimized ALT protocols contribute to improved patient outcomes and catheter management.