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Evaluating the compatibility, stability, and antimicrobial effectiveness of vancomycin and cefepime admixtures in

Richard W Dudley1, Susan J Lewis2,3, Mariann D Churchwell4

  • 1Department of Pharmaceutical Sciences, College of Pharmacy, University of Findlay, 1000 North Main Street, Findlay, OH, USA. dudley@findlay.edu.

Scientific Reports
|May 20, 2026
PubMed

Insights

This study found vancomycin and cefepime admixtures are compatible in peritoneal dialysis solutions. Refrigerated storage up to 7 days maintains stability, supporting combined antibiotic use for peritonitis treatment.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pharmaceutical Sciences

Background:

  • Peritoneal dialysis (PD) is a common home-based treatment for kidney failure.
  • Peritonitis is a serious complication of PD, often treated with intraperitoneal (IP) antibiotics.
  • Limited data exist on the compatibility of commonly used antibiotics like vancomycin and cefepime in PD solutions.

Purpose of the Study:

  • To evaluate the in vitro physical compatibility, chemical stability, and antimicrobial activity of vancomycin and cefepime admixtures in PD solutions.
  • To determine optimal storage conditions and duration for combined vancomycin-cefepime therapy in PD.
  • To provide evidence supporting the combined use of these antibiotics for peritonitis management in PD patients.

Main Methods:

  • Vancomycin and cefepime were admixed in Dianeal 2.5% and Extraneal 7.5% PD solutions.
  • Admixtures were stored at 4°C, 25°C, and 37°C for 168 hours.
  • Assessed physical compatibility, chemical stability (HPLC, pH), and antimicrobial activity (disk diffusion, MIC) against Staphylococcus aureus and Pseudomonas aeruginosa.

Main Results:

  • All admixtures were physically compatible.
  • At 4°C, both antibiotics maintained >90% concentration for 168 hours.
  • At 25°C, vancomycin was stable throughout; cefepime stability ranged from 72-168 hours.
  • At 37°C, vancomycin was stable for 120-168 hours, while cefepime stability was 8-24 hours.
  • Antimicrobial activity was preserved for 120 hours across all conditions.

Conclusions:

  • Vancomycin and cefepime admixtures are physically compatible in PD solutions.
  • Refrigerated storage (4°C) up to 7 days supports the stability of both antibiotics.
  • At 37°C, cefepime stability of 8-24 hours exceeds the minimum IP dwell time, supporting its use in combination therapy.
Keywords:
AntibioticsCompatibilityHPLCPeritoneal dialysisPeritonitisStability

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