desensitization protocols - michigan medicinedesensitization protocols see also, umhhc policy...

DESENSITIZATION PROTOCOLS

See also, UMHHC Policy 07-01-017. Desensitization Policy for Drug Hypersensitivity for Inpatients for information regarding dosing intervals, infusion times, IV access requirements and monitoring.

CONTENTS

Amiodarone

Ampicillin

Ampicillin/Sulbactam

Aspirin

Atovaquone

Aztreonam

Cefazolin

Cefepime

Ceftazidime

Ceftriaxone

Ciprofloxacin

Clopidogrel

Levofloxacin

Linezolid

Meropenem

Metronidazole

Nafcillin

Penicillin G

Piperacillin/Tazobactam

Tigecycline

Vancomycin

https://michmed-clinical.policystat.com/policy/6410072/latest/

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AMIODARONE

STEP 1: PHARMACY – PREPARE AND LABEL SERIAL DILUTIONS

STEP 2: PHARMACY - PREPARE IV DOSES Goal dose 150 mg:

Dose # Dose Volume Bag #

1 0.01 mg 1 mL Bag 3 (0.01 mg/mL)

2 0.03 mg 3 mL

3 0.05 mg 5 mL

4 0.1 mg 10 mL

5 0.3 mg 30 mL

6 1 mg 1 mL Bag 2 (1 mg/mL)

7 3 mg 3 mL

8 5 mg 5 mL

9 10 mg 10 mL

10 30 mg 30 mL

11 (cumulative 150 mg) 100 mg 100 mL

Goal dose 300 mg:

Dose # Dose Volume Bag #

1 0.01 mg 1 mL Bag 3 (0.01 mg/mL)

2 0.03 mg 3 mL

3 0.05 mg 5 mL

4 0.1 mg 10 mL

5 0.3 mg 30 mL

6 1 mg 1 mL Bag 2 (1 mg/mL)

7 3 mg 3 mL

8 5 mg 5 mL

9 10 mg 10 mL

10 30 mg 30 mL

11 100 mg 100 mL

12 (cumulative 300 mg) 150 mg 100 mL Bag 1 (1.5 mg/mL)

Note: Doses should be given 30 minutes apart

Bag Concentration

1. Remove 13 mL out of 100 mL D5W bag

2. Inject 150 mg/3 mL of amiodarone into 100 mL D5W (Bag #1) 1.5 mg/mL

3. Remove 12 mL out of 100 mL D5W bag

4. Inject 100 mg/2 mL of amiodarone into 100 mL D5W (Bag #2) 1 mg/mL

5. Remove 11 mL out of 100 mL D5W Bag #2

6. Inject 1 mL of Bag #1 into 100 mL D5W (Bag #3) 0.01 mg/mL

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Ampicillin

STEP 1: PREPARE AND LABEL SERIAL DILUTIONS

Vial Concentration

1. Dilute 1 g AMPICILLIN vial with 9.5 mL SW, label vial #1 100 mg/mL

2. 0.1 mL of vial 1 plus 9.9 mL SW into an empty vial, label vial #2 1 mg/mL

3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial, label vial #3 0.01 mg/mL

STEP 2: PREPARE IV DOSES Goal dose 1 g:

Dose # Dose Volume Vial #

1 0.01 mg 1 mL #3 (0.01 mg/mL)

2 0.05 mg 5 mL

3 0.1 mg 0.1 mL #2 (1 mg/mL)

4 0.5 mg 0.5 mL

5 1 mg 1 mL

6 3 mg 3 mL

7 5 mg 5 mL

8 10 mg 0.1 mL #1 (100 mg/mL)

9 30 mg 0.3 mL

10 50 mg 0.5 mL

11 100 mg 1 mL

12 300 mg 3 mL

13 500 mg 5 mL

Goal dose 2 g:


1 0.01 mg 1 mL #3 (0.01 mg/mL)

2 0.03 mg 3 mL

3 0.05 mg 5 mL

4 0.1 mg 0.1 mL #2 (1 mg/mL)

5 0.3 mg 0.3 mL

6 0.5 mg 0.5 mL

7 1 mg 1 mL

8 3 mg 3 mL

9 5 mg 5 mL

10 10 mg 0.1 mL #3 (100 mg/mL

11 30 mg 0.3 mL

12 50 mg 0.5 mL

13 100 mg 1 mL

14 300 mg 3 mL

15 500 mg 5 mL

16 1 g Add-Vantage 1 g Add-Vantage vial assembled with 50 mL NS

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Ampicillin/Sulbactam


Vial Concentration

1. Dilute 3 g Unasyn vial with 6.4 mL NS, label vial #1 375 mg/mL

2. 4 mL of vial 1 plus 11 mL NS into an empty vial, label vial #2 100 mg/mL

3. 0.1 mL of vial 2 plus 9.9 mL NS into an empty vial, label vial #3 1 mg/mL

4. 0.1 mL of vial 3 plus 9.9 mL NS into an empty vial, label vial #4 0.01 mg/mL

STEP 2: PREPARE IV DOSES Goal 1.5 g


1 0.015 mg 1.5 mL 4 (0.01 mg/mL) 2 0.03 mg 3 mL

3 0.15 mg 0.15 mL 3 (1 mg/mL)

4 0.3 mg 0.3 mL

5 1.5 mg 1.5 mL

6 3 mg 3 mL

7 4.5 mg 4.5 mL

8 15 mg 0.15 mL 2 (100 mg/mL)

9 30 mg 0.3 mL

10 45 mg 0.45 mL

11 150 mg 1.5 mL

12 300 mg 3 mL

13 450 mg 4.5 mL

14 cumulative 1.5 g 500 mg 1.33 mL 1 (375 mg/mL)

Goal 3 g


1 0.01 mg 1 mL 4 (0.01 mg/mL)

2 0.03 mg 3 mL

3 0.1 mg 0.1 mL 3 (1 mg/mL)

4 0.3 mg 0.3 mL

5 1 mg 1 mL

6 3 mg 3 mL

7 10 mg 0.1 mL 2 (100 mg/mL)

8 30 mg 0.3 mL

9 100 mg 1 mL

10 300 mg 3 mL

11 1 g 2.67 mL 1 (375 mg/mL)

12 cumulative 3 g 1.5 g Add-Vantage 1.5 g Add-Vantage assembled with 50 mL NS

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ASPIRIN

STEP 1: ADMINISTER ASPIRIN DOSES USING ASPIRIN TABLETS

Dose # Dose Dosage Form

1 20.25 mg ¼ of 81 mg tab

2 40.5 mg ½ of 81 mg tab

3 40.5 mg ½ of 81 mg tab

4 81 mg 81 mg tab

5 121.5 mg 1 ½ 81 mg tab

6 202.5 mg 2 ½ 81 mg tab

7 325 mg 325 mg tab

Notes: Doses are to be given orally Doses should be given 90 – 180 minutes apart Patient must not react to a dose before moving on to an escalating dose Reference: White AA, Stevenson DD, Woessner KM, et al. Approach to patients with aspirin hypersensitivity and acute cardiovascular emergencies. Allergy Asthma Proc. 34:138-142, 2013.

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Atovaquone Oral Suspension (150 mg/mL)


Vial Concentration

1. 1 mL of stock suspension (150 mg/mL) mixed with 14 mL SW, labeled #1 10 mg/mL

2. 1 mL of vial #1 plus 9 mL SW into an empty vial, labeled #2 1 mg/mL

3. 1 mL of vial #2 plus 9 mL SW into an empty vial, labeled #3 0.1 mg/mL

STEP 2: PREPARE PO DOSES Goal 750 mg


1 0.1 mg 1 mL 3 (0.1 mg/mL) 2 0.3 mg 3 mL

3 0.5 mg 5 mL

4 1 mg 1 mL 2 (1 mg/mL)

5 3 mg 3 mL

6 5 mg 5 mL

7 10 mg 1 mL 1 (10 mg/mL) 8 30 mg 3 mL

9 50 mg 5 mL

10 100 mg 0.67 mL Stock suspension (150 mg/mL)

11 500 mg 3.33 mL

Goal 1.5 g


1 0.1 mg 1 mL 3 (0.1 mg/mL) 2 0.3 mg 3 mL

3 0.5 mg 5 mL

4 1 mg 1 mL 2 (1 mg/mL)

5 3 mg 3 mL

6 5 mg 5 mL

7 10 mg 1 mL 1 (10 mg/mL) 8 30 mg 3 mL

9 50 mg 5 mL

10 100 mg 0.67 mL Stock suspension (150 mg/mL)

11 500 mg 3.33 mL

12 750 mg 5 mL

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Aztreonam


Vial Concentration

1. Dilute 1 g AZTREONAM vial with 10 mL SW. Label as vial #1. 100 mg/mL

2. 0.1 mL of vial 1 plus 9.9 mL SW into an empty vial, labeled #2 1 mg/mL

3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial, labeled #3 0.01 mg/mL

STEP 2: PREPARE IV DOSES Goal dose 1 g


1 0.01 mg 1 mL 3 (0.01 mg/mL)

2 0.05 mg 5 mL

3 0.1 mg 0.1 mL 2 (1 mg/mL)

4 0.5 mg 0.5 mL

5 1 mg 1 mL

6 3 mg 3 mL

7 5 mg 5 mL

8 10 mg 0.1 mL 1 (100 mg/mL)

9 30 mg 0.3 mL

10 50 mg 0.5 mL

11 100 mg 1 mL

12 300 mg 3 mL

13 500 mg 5 mL

Goal dose 2 g


1 0.01 mg 1 mL 3 (0.1 mg/mL)

2 0.03 mg 3 mL

3 0.05 mg 5 mL

4 0.1 mg 0.1 mL 2 (1 mg/mL)

5 0.3 mg 0.3 mL

6 0.5 mg 0.5 mL

7 1 mg 1 mL

8 3 mg 3 mL

9 5 mg 5 mL

10 10 mg 0.1 mL 1 (100 mg/mL)

11 30 mg 0.3 mL

12 50 mg 0.5 mL

13 100 mg 1 mL

14 300 mg 3 mL

15 500 mg 5 mL

16 1 g 1 g vial in 50 mL

Corrected August 7, 2013.

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Cefazolin


Vial Concentration

1. Dilute 1 g CEFAZOLIN vial with 9.6 mL SW, label vial #1 100 mg/mL


3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial , labeled #3 0.01 mg/mL

STEP 2: PREPARE IV DOSES Goal dose 500 mg


1 0.01 mg 1 mL 3 (0.01 mL)

2 0.05 mg 5 mL

3 0.1 mg 0.1 mL 2 (1 mg/mL)

4 0.5 mg 0.5 mL

5 1 mg 1 mL

6 5 mg 5 mL

7 10 mg 0.1 mL 1 (100 mg/mL)

8 30 mg 0.3 mL

9 50 mg 0.5 mL

10 100 mg 1 mL

11 300 mg 3 mL

Goal dose 1 g


1 0.01 mg 1 mL 3 (0.01 mg/mL)

2 0.05 mg 5 mL

3 0.1 mg 0.1 mL 2 (1 mg/mL)

4 0.5 mg 0.5 mL

5 1 mg 1 mL

6 3 mg 3 mL

7 5 mg 5 mL

8 10 mg 0.1 mL 1 (100 mg/mL)

9 30 mg 0.3 mL

10 50 mg 0.5 mL

11 100 mg 1 mL

12 300 mg 3 mL

13 500 mg 5 mL

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Cefazolin, continued Goal dose 2 g


1 0.01 mg 1 mL 3 (0.01 mg/mL)

2 0.03 mg 3 mL

3 0.05 mg 5 mL

4 0.1 mg 0.1 mL 2 (1 mg/mL

5 0.3 mg 0.3 mL

6 0.5 mg 0.5 mL

7 1 mg 1 mL

8 3 mg 3 mL

9 5 mg 5 mL

10 10 mg 0.1 mL 1 (100 mg/mL)

11 30 mg 0.3 mL

12 50 mg 0.5 mL

13 100 mg 1 mL

14 300 mg 3 mL

15 500 mg 5 mL

16 1 g 1 g Add-Vantage in 50 mL

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Cefepime


Vial Concentration

1. Dilute 1 g CEFEPIME vial with 10 mL SW, label vial #1 100 mg/mL





1 0.01 mg 1 mL 3 (0.01 mg/mL)

2 0.05 mg 5 mL

3 0.1 mg 0.1 mL 2 (1 mg/mL)

4 0.5 mg 0.5 mL

5 1 mg 1 mL

6 3 mg 3 mL

7 5 mg 5 mL

8 10 mg 0.1 mL 1 (100 mg/mL)

9 30 mg 0.3 mL

10 50 mg 0.5 mL

11 100 mg 1 mL

12 300 mg 3 mL

13 500 mg 5 mL

Goal dose 2 g


1 0.01 mg 1 mL 3 (0.01 mg/mL)

2 0.03 mg 3 mL

3 0.05 mg 5 mL

4 0.1 mg 0.1 mL 2 (1 mg/mL)

5 0.3 mg 0.3 mL

6 0.5 mg 0.5 mL

7 1 mg 1 mL

8 3 mg 3 mL

9 5 mg 5 mL

10 10 mg 0.1 mL 1 (100 mg/mL)

11 30 mg 0.3 mL

12 50 mg 0.5 mL

13 100 mg 1 mL

14 300 mg 3 mL

15 500 mg 5 mL

16 1 g over 30 min Mini-bag plus or Add-Ease

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Ceftazidime


Vial Concentration

1. Dilute 1 g CEFTAZIDIME vial with 10 mL SW, label vial #1 100 mg/mL





1 0.01 mg 1 mL 3 (0.01 mg/mL)

2 0.05 mg 5 mL

3 0.1 mg 0.1 mL 2 (1 mg/mL)

4 0.5 mg 0.5 mL

5 1 mg 1 mL

6 5 mg 5 mL

7 10 mg 0.1 mL 1 (100 mg/mL)

8 30 mg 0.3 mL

9 50 mg 0.5 mL

10 100 mg 1 mL

11 300 mg 3 mL

Goal dose 1 g


1 0.01 mg 1 mL 3 (0.01 mL)

2 0.05 mg 5 mL

3 0.1 mg 0.1 mL 2 (1 mg/mL)

4 0.5 mg 0.5 mL

5 1 mg 1 mL

6 3 mg 3 mL

7 5 mg 5 mL

8 10 mg 0.1 mL 1 (100 mg/mL)

9 30 mg 0.3 mL

10 50 mg 0.5 mL

11 100 mg 1 mL

12 300 mg 3 mL

13 500 mg 5 mL

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Ceftazidime, continued

Goal dose 2 g


1 0.01 mg 1 mL 3 (0.01 mg/mL)

2 0.03 mg 3 mL

3 0.05 mg 5 mL

4 0.1 mg 0.1 mL 2 (1 mg/mL)

5 0.3 mg 0.3 mL

6 0.5 mg 0.5 mL

7 1 mg 1 mL

8 3 mg 3 mL

9 5 mg 5 mL

10 10 mg 0.1 mL 1 (100 mg/mL)

11 30 mg 0.3 mL

12 50 mg 0.5 mL

13 100 mg 1 mL

14 300 mg 3 mL

15 500 mg 5 mL

16 1 g Add-Vantage

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Ceftriaxone


Vial Concentration

1. Dilute 1 g CEFTRIAXONE vial with 9.6 mL SW, label vial #1 100 mg/mL





1 0.01 mg 1 mL 3 (0.01 mg/mL)

2 0.05 mg 5 mL

3 0.1 mg 0.1 mL 2 (1 mg/mL)

4 0.5 mg 0.5 mL

5 1 mg 1 mL

6 3 mg 3 mL

7 5 mg 5 mL

8 10 mg 0.1 mL 1 (100 mg/mL)

9 30 mg 0.3 mL

10 50 mg 0.5 mL

11 100 mg 1 mL

12 300 mg 3 mL

13 500 mg 5 mL

Goal dose 2 g


1 0.01 mg 1 mL 3 (0.01 mg/mL)

2 0.03 mg 3 mL

3 0.05 mg 5 mL

4 0.1 mg 0.1 mL 2 (1 mg/mL)

5 0.3 mg 0.3 mL

6 0.5 mg 0.5 mL

7 1 mg 1 mL

8 3 mg 3 mL

9 5 mg 5 mL

10 10 mg 0.1 mL 3 (100 mg/mL)

11 30 mg 0.3 mL

12 50 mg 0.5 mL

13 100 mg 1 mL

14 300 mg 3 mL

15 500 mg 5 mL

16 1 g Add-Vantage

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Ciprofloxacin


Vial Concentration

1. Inject 0.5 mL Cipro (2 mg/mL) plus 9.5 mL D5W into an empty vial labeled #1 0.1 mg/mL

2. 1 mL of vial 1 plus 9 mL D5W into an empty vial labeled #2 0.01 mg/mL

3. 1 mL of vial 2 plus 9 mL D5W into an empty vial labeled #3 0.001 mg/mL



1 0.01 mg 1 mL 2 (0.01 mg/mL)

2 0.05 mg 5 mL

3 0.1 mg 1 mL 1 (0.1 mg/mL)

4 0.5 mg 5 mL

5 1 mg 0.5 mL Bag (2 mg/mL)

6 5 mg 2.5 mL

7 10 mg 5 mL

8 20 mg 10 mL

9 50 mg 25 mL

10 100 mg 50 mL

11 200 mg over 60 min 200 mg premix bag

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CLOPIDOGREL

STEP 1: PHARMACY - PREPARE AND LABEL SERIAL DILUTION SOLUTIONS

Directions Concentration

1. Triturate 1 clopidogrel 75 mg tablet into a fine powder. Transfer powder to a 100 mL graduated cylinder. Rinse remaining powder in mortar with sterile water for irrigation and transfer to graduate. Add q.s. to 25 mL with sterile water for irrigation. Label graduate solution #1

3 mg/mL

2. Transfer 1 mL of clopidogrel 3 mg/mL solution to a new graduated cylinder plus 29 mL sterile water for irrigation. Label as solution #2

0.1 mg/mL

Goal dose 75 mg (please note all doses solution)


1 0.02 0.2 mL 2 (0.1 mg/mL)

2 0.05 0.5 mL

3 0.15 1.5 mL

4 0.5 5 mL

5 1.5 0.5 mL 1 (3 mg/mL)

6 5 1.7 mL

7 15 5 mL

8 45 15 mL

Notes: Doses are to be given orally Doses should be given 30 minutes apart Initiate 75 mg clopidogrel 24 hours later. Reference: Sanchez-Lopez J, Munoz-Cano R, Bartra A, et al. Desensitization to clopidogrel: a growing need. Allergy. 65 (2010); 274-280.

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Levofloxacin


Vial Concentration

1. Inject 1 mL LEVOFLOXACIN (5 mg/mL) plus 9 mL SW 0.5 mg/mL

2. 1 mL of vial 1 plus 9 mL SW into an empty vial, labeled #2 0.05 mg/mL




1 0.01 mg 0.2 mL 2 (0.05 mg/mL)

2 0.05 mg 1 mL

3 0.1 mg 2 mL

4 0.5 mg 1 mL 1 (0.5 mg/mL)

5 1 mg 2 mL

6 5 mg 1 mL Bag (5 mg/mL)

7 10 2 mL

8 30 mg 6 mL

9 50 mg 10 mL

10 100 mg 20 mL

11 300 mg over 60 minutes 60 mL

Goal dose 750 mg


1 0.01 mg 0.2 mL 2 (0.05 mg/mL)

2 0.05 mg 1 mL

3 0.1 mg 2 mL

4 0.5 mg 1 mL 1 (0.5 mg/mL)

5 1 mg 2 mL

6 5 mg 1 mL Bag (5 mg/mL)

7 10 mg 2 mL

8 25 mg 5 mL

9 50 mg 10 mL

10 75 mg 15 mL

11 100 mg 20 mL

12 500 mg over 60 minutes 500 mg premix bag

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LINEZOLID

STEP 1: PHARAMCY - PREPARE AND LABEL SERIAL DILUTIONS

STEP 2: PHARMACY - PREPARE IV DOSES Goal dose 600 mg

Dose # Dose Volume Rate Bag #

1 0.03 mg 1.5 mL 18 mL/h #3 (0.02 mg/mL)

2 0.07 mg 3.5 mL 42 mL/h

3 0.15 mg 0.75 mL 9 mL/h #2 (0.2 mg/mL)

4 0.3 mg 1.5 mL 18 mL/h

5 0.6 mg 3 mL 36 mL/h

6 1.2 mg 6 mL 72 mL/h

7 2.3 mg 1.2 mL 13.8 mL/h #1 (2 mg/mL)

8 4.7 mg 2.3 mL 28.2 mL/h

9 9.4 mg 4.7 mL 56.4 mL/h

10 18.75 mg 9.4 mL 112.5 mL/h

11 37.5 mg 18.8 mL 225 mL/h

12 75 mg 37.5 mL 450 mL/h

13 150 mg 75 mL 300 mL/h

14 300 mg 150 mL 600 mL/h

Note: Infuse doses 1-12 over five minutes and infuse doses 13-14 over fifteen minutes; wait ten minutes between each dose Reference: Bagwell AD, Stollings JL, White KD, et al. Linezolid desensitization for a patient with multiple medication hypersensitivity reactions. Ann Pharmacother. 2013; 47:e30.

Bag Concentration

1. Premixed bag of linezolid 600 mg/300 mL of D5W, label #1 2 mg/mL

2. 10 mL from bag 1 plus 90 mL D5W, labeled #2 0.2 mg/mL

3. 10 mL from bag 2 plus 90 mL D5W, labeled #3 0.02 mg/mL

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Meropenem


Vial Concentration

1. Dilute 1 g MEROPENEM vial with 20 mL SW label vial #1 50 mg/mL





1 0.01 mg 2 mL 3 (0.005 mg/mL)

2 0.05 mg 10 mL

3 0.1 mg 0.2 mL 2 (0.5 mg/mL)

4 0.5 mg 1 mL

5 1 mg 2 mL

6 5 mg 10 mL

7 10 0.2 mL 1 (50 mg/mL)

8 30 mg 0.6 mL

9 50 mg 1 mL

10 100 mg 2 mL

11 300 mg 6 mL

Goal dose 1 g


1 0.01 mg 2 mL 3 (0.005 mg/mL)

2 0.05 mg 10 mL

3 0.1 mg 0.2 mL 2 (0.5 mg/mL)

4 0.5 mg 1 mL

5 1 mg 2 mL

6 3 mg 6 mL

7 5 mg 10 mL

8 10 mg 0.2 mL 1 (50 mg/mL)

9 30 mg 0.6 mL

10 50 mg 1 mL

11 100 mg 2 mL 1 (50 mg/mL)

12 300 mg 6 mL

13 500 mg 10 mL

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Meropenem, continued

Goal dose 2 g


1 0.01 mg 2 mL 3 (0.005 mg/mL)

2 0.03 mg 6 mL

3 0.05 mg 10 mL

4 0.1 mg 0.2 mL 2 (0.5 mg/mL)

5 0.3 mg 0.6 mL

6 0.5 mg 1 mL

7 1 mg 2 mL

8 3 mg 6 mL

9 5 mg 10 mL

10 10 mg 0.2 mL 1 (50 mg/mL)

11 30 mg 0.6 mL

12 50 mg 1 mL

13 100 mg 2 mL

14 300 mg 6 mL

15 500 mg 10 mL

16 1 g Mini-Bag Plus or Add-Ease

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METRONIDAZOLE

STEP 1: PHARMACY - PREPARE AND LABEL SERIAL DILUTIONS

Bag/Vial Concentration

1. Use metronidazole 500 mg/100 mL pre-manufactured IV bag. Label as Bag #1. 5 mg/mL

2. 1 mL of Bag #1 plus 9 mL NS into an empty vial, labeled #2 0.5 mg/mL

3. 1 mL of vial #2 plus 9 mL NS into an empty vial, labeled #3 0.05 mg/mL

4. 1 mL of vial #3 plus 9 mL NS into an empty vial, labeled #4 0.005 mg/mL

STEP 2: PHARMACY - PREPARE IV DOSES Goal dose 500 mg

Dose # Dose Volume Bag/Vial #

1 0.005 mg 1 mL 4 (0.005 mg/mL)

2 0.015 mg 3 mL

3 0.05 mg 1 mL 3 (0.05 mg/mL)

4 0.15 mg 3 mL

5 0.5 mg 1 mL 2 (0.5 mg/mL)

6 1.5 mg 3 mL

7 5 mg 1 mL

1 (5 mg/mL)

8 25 mg 5 mL

9 50 mg 10 mL

10 150 mg 30 mL

11 250 mg 50 mL

12 Then follow scheduled interval 500 mg dosing

Notes: Intravenous increments are administered at 15 minute intervals Infuse doses 1-2 over 10 minutes, doses 3-11 over 15 minutes, and dose 12 over 30 minutes Goal dose 2 g

Dose # Dose Volume Bag/Vial #

1 0.005 mg 1 mL 4 (0.005 mg/mL)

2 0.015 mg 3 mL

3 0.05 mg 1 mL 3 (0.05 mg/mL)

4 0.15 mg 3 mL

5 0.5 mg 1 mL 2 (0.5 mg/mL)

6 1.5 mg 3 mL

7 5 mg 1 mL

1 (5 mg/mL)

8 25 mg 5 mL

9 50 mg 10 mL

10 150 mg 30 mL

11 250 mg 50 mL

12 500 mg 100 mL Pre-manufactured 500 mg/100 mL bag 13 1 g 200 mL

14 Then follow scheduled interval 2 g dosing

Notes: Intravenous increments are administered at 15 minute intervals Infuse doses 1-2 over 10 minutes, doses 3-11 over 15 minutes, dose 12 over 30 minutes, and doses 13-14 over 60 minutes Reference: Pearlman MD, Yashar C, Ernst S, Solomon W. An incremental dosing protocol for women with severe vaginal trichomoniasis and adverse reactions to metronidazole. Am J Obstet Gynecol. 1996; 174;934-6.

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Nafcillin


Vial Concentration

1. Dilute 1 g NAFCILLIN vial with 8.3 mL SW, label vial #1 100 mg/mL





1 0.01 mg 1 mL 3 (0.01 mg/mL)

2 0.05 mg 5 mL

3 0.1 mg 0.1 mL 2 (1 mg/mL)

4 0.5 mg 0.5 mL

5 1 mg 1 mL

6 3 mg 3 mL

7 5 mg 5 mL

8 10 mg 0.1 mL 1 (100 mg/mL)

9 30 mg 0.3 mL

10 50 mg 0.5 mL

11 100 mg 1 mL

12 300 mg over 30 min 3 mL


Goal dose 2 g


1 0.01 mg 1 mL 3 (0.01 mg/mL)

2 0.03 mg 3 mL

3 0.05 mg 5 mL

4 0.1 mg 0.1 mL 2 (1 mg/mL)

5 0.3 mg 0.3 mL

6 0.5 mg 0.5 mL

7 1 mg 1 mL

8 3 mg 3 mL

9 5 mg 5 mL

10 10 mg 0.1 mL 1 (100 mg/mL)

11 30 mg 0.3 mL

12 50 mg 0.5 mL

13 100 mg 1 mL



16 1 g over 30-60 min Add-Vantage

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Penicillin G


Vial Concentration

1. Dilute 5,000,000 unit PENICILLIN G vial with 8 mL SW label vial #1 500,000 units/mL

2. 1 mL of vial 1 plus 9 mL SW into an empty vial, labeled #2 50,000 units/mL

3. 1 mL of vial 2 plus 9 mL SW into an empty vial, labeled #3 5,000 units/mL

4. 1 mL of vial 3 plus 9 mL SW into an empty vial, labeled #4 500 units/mL



STEP 2: PREPARE IV DOSES Goal dose 2.5 million units


1 1 unit 0.2 mL 6 (5 units/mL)

2 5 units 1 mL

3 10 units 2 mL

4 50 units 1 mL 5 (50 units/mL)

5 100 units 2 mL


7 750 units 1.5 mL

8 1,000 units 2 mL

9 5,000 units 1 mL 3 (5,000 units/mL)

10 7,500 units 1.5 mL

11 10,000 units 2 mL

12 50,000 units 1 mL 2 (50,000 units/mL)

13 75,000 units 1.5 mL

14 100,000 units 2 mL

15 500,000 units 1 mL 1 (500,000 units/mL)

16 750,000 units 1.5 mL

17 1,000,000 units 2 mL

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Penicillin G, continued Goal dose 3 million units



2 5 units 1 mL

3 10 units 2 mL


5 100 units 2 mL


7 750 units 1.5 mL

8 1,000 units 2 mL

9 5,000 units 1 mL 3 (5,000 units/mL)

10 7,500 units 1.5 mL

11 10,000 units 2 mL

12 50,000 units 1 mL 2 (50,000 units/mL)

13 75,000 units 1.5 mL

14 100,000 units 2 mL

15 500,000 units 1 mL 1 (500,000 units/mL)

16 1,000,000 units 2 mL

17 1,250,000 units 2.5 mL

Goal dose 4 million units



2 5 units 1 mL

3 10 units 2 mL


5 100 units 2 mL


7 1,000 units 2 mL

8 5,000 units 1 mL 3 (5,000 units/mL)

9 10,000 units 2 mL

10 30,000 units 0.6 mL 2 (50,000 units/mL)

11 50,000 units 1 mL

12 100,000 units 2 mL

13 300,000 units 0.6 mL 1 (500,000 units/mL)

14 500,000 units 1 mL

15 750,000 units 1.5 mL

16 1,000,000 units 2 mL

17 1,250,000 units 2.5 mL

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Piperacillin/tazobactam (Zosyn)


Vial Concentration

1. Dilute 3.375 g ZOSYN vial with 16.9 mL SW label vial #1 200 mg/mL

2. 5 mL of vial 1 plus 5 mL SW into an empty vial, labeled #2 100 mg/mL



STEP 2: PREPARE IV DOSES Goal dose 3.375 g

Goal dose 4.5 g


1 0.01 mg 1 mL 4 (0.01 mg/mL)

2 0.05 mg 5 mL

3 0.1 mg 0.1 mL 3 (1 mg/mL)

4 0.5 mg 0.5 mL

5 1 mg 1 mL

6 5 mg 5 mL

7 10 mg 0.1 mL 2 (100 mg/mL)

8 50 mg 0.5 mL

9 100 mg 1 mL

10 200 mg 2 mL

11 500 mg 2.5 1 (200 mg/mL)

12 1 g 5

13 1.5 g 7.5


1 0.01 mg 1 mL 4 (0.01 mg/mL)

2 0.05 mg 5 mL

3 0.1 mg 0.1 mL 3 (1 mg/mL)

4 0.5 mg 0.5 mL

5 1 mg 1 mL

6 5 mg 5 mL

7 10 mg 0.1 mL 2 (100 mg/mL)

8 50 mg 0.5 mL

9 75 mg 0.75 mL

10 100 mg 1 mL 2 (100 mg/mL)

11 250 mg 2.5 mL

12 500 mg 5 mL

13 750 mg 3.75 mL 1 (200 mg/mL)

14 1250 mg 6.25 mL

15 1.5 g 7.5 mL

http://ummcpharmweb.med.umich.edu/i/docs?xsdid=1013&file=SAMPLE_ZOSYN_DESENSITIZATION.pdf

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Tigecycline


Vial Concentration

1. Dilute 2 x 50 mg TIGECYCLINE vials each with 5.3 mL D5W or NS, label both vials #1 10 mg/mL

2. 1 mL of vial 1 plus 9 mL D5W or NS into an empty vial labeled #2 1 mg/mL

3. 1 mL of vial 2 plus 9 mL D5W or NS into an empty vial labeled #3 0.1 mg/mL

4. 1 mL of vial 3 plus 9 mL D5W or NS into an empty vial labeled #4 0.01 mg/mL

STEP 2: PREPARE IV DOSES


1 0.001 mg 0.1 mL 4 (0.01 mg/mL) 2 0.005 mg 0.5 mL

3 0.01 mg 1 mL

4 0.05 mg 5 mL

5 0.1 mg 1 mL 3 (0.1 mg/mL)

6 0.5 mg 5 mL

7 1 mg 1 mL 2 (1 mg/mL)

8 5 mg 5 mL

9 10 mg 1 mL 1 (10 mg/mL) 10 30 mg over 30 min 3 mL


Antimicrobial Subcommittee Approval: N/A Originated: Unknown

P&T Approval: N/A Last Revised: 02/2017

Revision History:

The recommendations in this guide are meant to serve as treatment guidelines for use at Michigan Medicine facilities. If you are an individual experiencing a medical

emergency, call 911 immediately. These guidelines should not replace a provider’s professional medical advice based on clinical judgment, or be used in lieu of an

Infectious Diseases consultation when necessary. As a result of ongoing research, practice guidelines may from time to time change. The authors of these guidelines

have made all attempts to ensure the accuracy based on current information, however, due to ongoing research, users of these guidelines are strongly encouraged to

confirm the information contained within them through an independent source.

If obtained from a source other than med.umich.edu/asp, please visit the webpage for the most up-to-date document.

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Vancomycin


Vial Concentration

1. Dilute 1 g VANCOMYCIN vial with 20 mL SW, label vial #1 50 mg/mL

2. 1 mL of vial 1 plus 9 mL SW into an empty vial, labeled #2 5 mg/mL





1 0.01 mg 0.2 mL 4 (0.05 mg/mL)

2 0.05 mg 1 mL

3 0.1 mg 2 mL

4 0.5 mg 1 mL 3 (0.5 mg/mL)

5 1 mg 2 mL

6 3 mg 6 mL

7 5 mg 1 mL 2 (5 mg/mL)

8 10 mg 2 mL

9 30 mg 6 mL

10 50 mg 1 mL 1 (50 mg/mL)

11 100 mg 2 mL


13 500 mg over 60 min Add-Vantage

desensitization protocols - michigan medicinedesensitization protocols see also, umhhc policy...

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