i
Antimicrobial Dilution Protocol (AmDP)
This is a general guide for dilution of antimicrobial injections within
MOH facilities in Penang State. Users are advised to refer to the
current practice at the respective facilities and update accordingly.
Pharmaceutical Services Division
Penang State Health Department
Ministry Of Health Malaysia
ii
Antimicrobial Dilution Protocol (AmDP)
ANTIMICROBIAL DILUTION PROTOCOL
First Edition 2016
This is a publication of Pharmaceutical Services Division, Penang State Health
Department. Enquiries are to be directed to the address below. Permission is hereby
granted to reproduce information contained herein provided that such reproduction
be given due acknowledgement and shall not modify the text.
This guideline can be downloaded from JKNPP website at
www.jknpenang.moh.gov.my
Pharmaceutical Services Division,
Penang State Health Department,
Aras 8, Bangunan Persekutuan,
Jalan Anson,
10400 Pulau Pinang,
Malaysia.
Tel: 04- 2292319
Fax: 04- 2280314
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Antimicrobial Dilution Protocol (AmDP)
ACKNOWLEDGEMENT
.
ELEDGEMENT
This guideline is an initiative by the Medication Safety Committee of Pharmaceutical Services Division, Penang State Health Department.
The committee would like to express our heartfelt gratitude to Dato’ Dr. Sukumar Mahesan
(Director of Penang State Health Department), Puan Zubaidah Binti Che’ Embee (Deputy Director Pharmacy of Penang State Health Department), members of reviewers, contributors and all those involve for their valuable and constructive comments in the completion of this guideline.
REVIEWERS
Dr. Wong Peng Shyan, Infectious Disease Consultant, Medical Department, Hospital Pulau Pinang
Dr. Loo Lay Khoon, Medical Specialist, Medical Department, Hospital Seberang Jaya
Madam Sherene Tan Su Ann, Pharmacist, Hospital Pulau Pinang
Madam Chua Cheah Chin, Pharmacist, Hospital Kepala Batas
Madam Che Ropani Binti Talib, State Matron, Penang State Health Department
Madam Saparbee Binti Mohamad, Senior Matron, Hospital Seberang Jaya
Madam Malathi D/O Govindasamy, Medical Ward Matron, Hospital Pulau Pinang
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Antimicrobial Dilution Protocol (AmDP)
CONTRIBUTORS
EDITORS
Oiyammaal D/O Maruthan Chelliah Pharmacist, Hospital Pulau Pinang
Syazleen Binti Razak Pharmacist, Hospital Pulau Pinang
Subramaniam S/O Thanimalai Pharmacist, Hospital Seberang Jaya
Celine Choong Yen Ching Pharmacist, Hospital Bukit Mertajam
Nurul Ain’ Binti Satar Pharmacist, Hospital Kepala Batas
Ong Chiou Ting Pharmacist, Hospital Sungai Bakap
Nasira Binti Mohamed Ayub Pharmacist, Hospital Balik Pulau
Tan Huey Yih Pharmacist, PKD Timur Laut
Ng Wei Min Pharmacist, PKD Barat Daya
Afida Amir Binti Ismet Amir Mohd. Idris Pharmacist, PKD Seberang Perai Utara
Tan Yin Shan Pharmacist, PKD Seberang Perai Selatan
Nurzawani Binti Yusof Pharmacist, PKD Seberang Perai Tengah
Tan Pei Ling Senior Assistant Director Pharmacy Practice and Development Division (Penang State)
Rohaizan Binti Mohd Hanafiah Senior Principle Assistant Director Pharmacy Practice and Development Division (Penang State)
Lim Shiou Hui Pharmacist, Hospital Pulau Pinang
Nasira Binti Mohamed Ayub Pharmacist, Hospital Balik Pulau
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Antimicrobial Dilution Protocol (AmDP)
The use of antimicrobial is very crucial in the treatment of infection and to prevent the
disease from spreading. Nevertheless, antimicrobial resistance in our country is at a
alarming level due to their frequent and widespread use in the health sector. Moreover,
the use of antimicrobial has been abused. Many strategies have been implemented
by Ministry of Health Malaysia to promote the appropriate use of antimicrobial and to
enhance the quality use of antimicrobial for optimum treatment outcome.
Consequently, this will control the spread of antimicrobial resistance.
Dilution of antimicrobial is one of the essential strategies to ensure the correct
reconstitution and dilution method of antimicrobial for effective, safe and optimum
result to the patient. The concentration of the final dilution of antimicrobial is important
to ensure the stability, quality and safety of the antimicrobial with minimal adverse drug
reactions. At the same time minimize the occurrence of medication errors of handling
antimicrobial in the wards.
This protocol is aim to give a quick , simple and comprehensive guide to all health care
providers especially those who handle reconstitution of antimicrobials in ward. It is a
guide to accurate and correct method in reconstitution or dilution of the antimicrobial
that is prescribed and at the same time minimize the occurrence of medication errors.
Finally, I would like to congratulate the committees who have contributed their time
and effort in establishing this protocol to ensure a safe and effective practice in Penang
state. I hope that this protocol will serve its purpose well in ensuring correct
reconstitution or dilution of antimicrobials and instilling safe medication handling in all
health care facilities in Penang state.
Thank you.
DATO’ DR. SUKUMAR MAHESAN
Director Penang State Health Department
FOREWORD
DIRECTOR PENANG STATE HEALTH DEPARTMENT
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Antimicrobial Dilution Protocol (AmDP)
Prompt antimicrobial therapy for an infection can make the difference between cure
and death or long-term disability. Unfortunately, the use and misuse of antimicrobials
has driven antimicrobial to resistance and led to a loss of efficacy of these “miracle
drugs”. Improving antimicrobial use decisions ultimately involves guiding treatment
decisions made by patients and healthcare providers and ensure the infected patients
have access to quality medicines.
Errors in reconstitution and dilution of antimicrobial are medication errors that reported
in our health care facilities. These errors will affect the patients’ treatment outcome,
increase the general health care cost and promote antimicrobial resistance. In order
to minimize this medication error, Pharmaceutical Services Division, Penang State
Health Department takes the initiative to establish a comprehensive and quick protocol
as a guide for all healthcare providers during the process of reconstitution or dilution
of antimicrobials that are available in our health care facilities.
All antimicrobials listed in this protocol are available in Malaysia market and our health
care facilities. This protocol will be useful in facilitating the health care providers in the
wards for correct reconstitution or dilution of antimicrobials. This list may be updated
from time to time if there is any new antimicrobial available in the market and edited
at the individual health care facilities.
Finally, I would like to express my appreciation to all the members in working
committee, editors and reviewers for their great effort and time in establishing this
protocol.
Thank you.
Deputy Director (Pharmacy) Of Penang State Health Department
FOREWORD
DEPUTY DIRECTOR (PHARMACY) OF PENANG
STATE HEALTH DEPARTMENT
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Antimicrobial Dilution Protocol (AmDP)
1. INTRODUCTION………………………………………………………………………………. 1
2. ABOUT AmDP………………………………………………………………………………….. 2
3. GUIDE IN USING AmDP……………………………………………………………………….. 3
4. GENERAL INFROMATION…………………………………………………………………….. 4
5. ANTIMICROBIAL DILUTION PROTOCOL
5.1 Acyclovir Inj………………………………………………………………………….. 5 - 8
5.2 Anidulafungin Inj…………………………………………………………………….. 9
` 5.3 Amikacin Inj………………………………………………………………………….. 10 - 11
5.4 Amoxycillin/ Clavulanate Inj………………………………………………………… 12 - 14
5.5 Ampicilin Inj………………………………………………………………………….. 15 - 17
5.6 Ampicillin/ Sulbactam Inj……………………………………………………………. 18 - 19
5.7 Amphotericin B Inj…………………………………………………………………… 20
5.8 Artesunate Inj………………………………………………………………………… 21
5.9 Azithromycin Inj……………………………………………………………………… 22
5.10 Benzathine Penicillin Inj…………………………………………………………….. 23
5.11 Benzylpenicillin Inj…………………………………………………………………… 24 - 25
5.12 Caspofungin Inj……………………………………………………………………… 26
5.13 Cefazolin Inj………………………………………………………………………….. 27
5.14 Cefepime Inj………………………………………………………………………….. 28 - 32
5.15 Cefotaxime Inj……………………………………………………………………….. 33 – 36
5.16 Cefoperazone Inj…………………………………………………………………….. 37
5.17 Cefoperazone/ Sulbactam Inj………………………………………………………. 38 – 40
5.18 Ceftaroline Inj………………………………………………………………………… 41
5.19 Ceftazidime Inj……………………………………………………………………….. 42 – 43
5.20 Ceftriaxone Inj……………………………………………………………………….. 44 – 45
5.21 Cefuroxime Inj……………………………………………………………………….. 46 – 47
5.22 Ciprofloxacin Inj……………………………………………………………………… 48 – 49
5.23 Clindamycin Inj………………………………………………………………………. 50 – 51
5.24 Cloxacillin Inj…………………………………………………………………………. 52
5.25 Doripenem Inj………………………………………………………………………... 53
5.26 Ertapenem Inj………………………………………………………………………... 54
5.27 Erythromycin Inj……………………………………………………………………… 55
5.28 Fluconazole Inj………………………………………………………………………. 56
5.29 Gentamicin Inj……………………………………………………………………….. 57
5.30 Imipenem/ Cilastatin Inj…………………………………………………………….. 58
5.31 Kanamycin Inj………………………………………………………………………... 59
5.32 Levofloxacin Inj………………………………………………………………………. 60 - 62
5.33 Linezolid Inj…………………………………………………………………………... 63
5.34 Meropenem Inj………………………………………………………………………. 64 – 67
5.35 Metronidazole Inj…………………………………………………………………….. 68
5.36 Moxifloxacin Inj………………………………………………………………………. 69
5.37 Netilmycin Inj………………………………………………………………………… 70 – 71
5.38 Pentamidine Inj………………………………………………………………………. 72
TABLE OF CONTENTS PAGES
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Antimicrobial Dilution Protocol (AmDP)
5.39 Piperacillin/ Tazobactam Inj……………………………………………………….. 73 – 76
5.40 Polymyxin B Inj……………………………………………………………………….. 77
5.41 Streptomycin Inj………………………………………………………………………. 78 - 80
5.42 Sulfamethoxazole/ Trimethoprim Inj……………………………………………….. 81
5.43 Vancomycin Inj……………………………………………………………………….. 82 – 83
5.44 Voriconazole Inj………………………………………………………………………. 84 – 85
5.45 Zidovudine Inj…………………………………………………………………………. 86
6. NON FORMULARY DILUTION PROTOCOL
6.1 Daptomycin Inj………………………………………………………………………… 87
6.2 Liposomal Amphotericin B Inj………………………………………………………... 88
6.3 Micafungin Sodium Inj………………………………………………………………… 89
6.4 Colistimethate Sodium (Polymyxcin E) Inj………………………………………….. 90
6.5 Tigecyclin Inj ………………………………………………………………………….. 91
6.6 Pentamidine Isothionate Inj………………………………………………………….. 92
6.7 Quinine Dihydrochloride Inj…………………………………………………………... 93
7. ABBREVIATION…………………………………………………………………………………. 94
8. REFERENCES……………………………………………………………………………………. 95 – 97
TABLE OF CONTENTS PAGES
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Antimicrobial Dilution Protocol (AmDP)
Intravenous therapy is the most important form of treatment in hospitalized
patients. It is essential to achieve desired plasma drug levels fast so that these patients
could obtain immediate therapeutic effect. Hence, intravenous antimicrobials provide
quick onset of action that safe patients’ life and minimize complication due to infection.
Contrary, these injectables can cause serious harm, not effective and lead to
antimicrobial resistant if prepared and given wrongly. For example, administration
intravenous Vancomycin in less than 60 minutes can cause “Red Man Syndrome”.
Study of Injectable Medication Errors done by American Nurses Association
revealed that 99% of nurses believed medication errors related to injectable
medication can cause serious harm to patient. Errors that occurred during preparation
and administration these medications accounted for 48% of the total error. Therefore,
a guide on dilution and administration of injectable medication serves as a proper
education that promotes safer medication practice at the healthcare facilities.
Reference:
Medication Errors and Syringe Safety Are Top Concerns for Nurses According to
New National Study [press release].
http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressRele
ases/2007/
INTRODUCTION
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Antimicrobial Dilution Protocol (AmDP)
Serves as a drug reference for Adult cases ONLY. Clinical
discretion is necessary tailoring to patient condition and
practice preference.
Included antibiotics, antivirals and antifungals injection listed in
Ministry of Health Formulary (Year 2015) and Non-formulary
Antimicrobial (KPK drug) available at health facilities in Penang
State.
All drugs available in Malaysia are listed with their brand names.
Healthcare providers may find the details according to brand name
if there is a change in brand.
Most of the information is based on brand and manufacturer
recommendation. Thus, may subject to change.
Drugs are listed alphabetical in orders and subclass according to
brand name.
Information might be the same for different brands. Thus there will
be more than one brand listed in one table. Example; brand Azee®
and Zitromax® for Azithromycin Injection.
ABOUT ANTIMICROBIAL DILUTION PROTOCOL (AmDP)
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Antimicrobial Dilution Protocol (AmDP)
1. Check the generic name of antimicrobial injection.
2. Check the brand name of antimicrobial injection.
3. Search page number of generic and brand name at content page.
4. Read all information in the table before reconstitute or dilute the
drugs.
5. If the drug or the brand is not listed in the protocol, contact
Pharmacy Department in respective healthcare facility for further
information.
GUIDE IN USING AmDP
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Antimicrobial Dilution Protocol (AmDP)
1. All preparations should be done using aseptic technique.112
2. Do NOT freeze medications.111
3. Do NOT use the initial concentrate or the infusion solution if there is any sign
of precipitation and presence of foreign matter in either one.111
4. Kindly refer to pharmacist if the medication changes in color upon
reconstitution unless stated otherwise in product insert.111
5. Do NOT mix other drugs to the infusion solution to avoid any possible drug
interactions.111
6. Any unused portion should be discarded after the recommended period of
use.111
7. For multiple use vials, reconstituted solution must be labelled with time and
date immediately after preparation112 and must be placed under
recommended storage condition.
8. Flush IV line with NS before and after administration.112
9. In general, slow intravenous injection is to be given over 3 – 5 minutes;
intravenous infusion over 30 - 60 minutes113 unless stated otherwise in
product insert.
This general information may not be applicable to all the medications
available. Please consult your pharmacist for further information.
References:
111. Intravenous Drugs Preparation & Administration Quick Reference, Medical Department &
Pharmacy Department Kuala Lumpur Hospital, 2011
112. John D & Rebecca L, 2010. Guide to the Safe Preparation and Administration of Intravenous (IV)
Antibiotics at Home. http://www.newcastle-
hospitals.org.uk/downloads/cardiothoracic/Patient_info_-_safe_prep_and_admin_of_IV_ab.pdf
113. Dilution Protocol 2010, Hospital Selayang 2nd
GENERAL INFORMATION
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Antimicrobial Dilution Protocol (AmDP)
1.1 BRAND : Zovirax ®
STRENGTH 250mg Powder
RECONSTITUTION/ DILUTION
IV : Reconstitute with 10ml WFI/ NS Further dilute with:
Dose To be diluted with
250mg – 500mg 100 ml NS
500mg – 1gm 200 ml NS
ADMINISTRATION Slow IV infusion over 1 hour
STABILITY
After Reconstitution After Dilution
RT RT
Used immediately after reconstitution
12 hours
DO NOT REFRIGERATE
INCOMPATIBILITY -
REMARKS -
Reference : 1. PRODUCT LEAFLET : Zovirax For Infusion 250mg, GlaxoSmithKline.
1.0 ACYCLOVIR INJECTION
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Antimicrobial Dilution Protocol (AmDP)
1.2 BRAND : Medovir ®
STRENGTH 250mg powder
RECONSTITUTION/ DILUTION
IV: Reconstitute
Dose Notes
250mg Reconstitute with 5ml NS/ WFI
500mg Reconstitute with 10ml NS/ WFI
Further dilute with NS to give concentration not greater than 5mg/ml (minimum volume can be diluted 10ml of NS to achieve concentration ≤ 5mg/ml)
ADMINISTRATION IV infusion over at least 1 hour
STABILITY
After Reconstitution After Dilution
RT RT
Used immediately after reconstitution
12 hours
DO NOT REFRIGERATE
INCOMPATIBILITY
Biological or colloidal solutions (blood products, protein containing solutions), Parabens
REMARKS -
Reference : 2. PRODUCT LEAFLET : Medovir 250mg Injectible, Medochemie.
1.0 ACYCLOVIR INJECTION
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Antimicrobial Dilution Protocol (AmDP)
1.3 BRAND : DBL Acyclovir Intravenous Infusion ®
STRENGTH 250mg Powder
RECONSTITUTION/ DILUTION
IV : Reconstitute
Dose Notes
250mg Reconstitute with 10ml NS/ WFI
500mg Reconstitute with 20ml NS/ WFI
Further dilute with NS to give concentration not greater than 5mg/ml (minimum volume can be diluted 10ml of NS to achieve concentration ≤ 5mg/ml)
ADMINISTRATION IV infusion only, to be given over a period at least 1 hour
STABILITY
After Reconstitution After Dilution
RT RT
Used immediately after reconstitution
12 hours
DO NOT REFRIGERATE
INCOMPATIBILITY -
REMARKS -
Reference : 3. PRODUCT LEAFLET : DBL Acyclovir Hospira.
1.0 ACYCLOVIR INJECTION
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Antimicrobial Dilution Protocol (AmDP)
1.4 BRAND : Vaxcel Acyclovir ®
STRENGTH 250mg in 10ml
RECONSTITUTION/ DILUTION
IV : Dilute 250mg with 50ml NS/ D5 Dilute 500mg with 100ml NS/ D5 - concentration not greater than 5mg/ml
ADMINISTRATION IV : Infuse over 1 hour by controlled infusion pump
STABILITY
To be diluted immediately before use.
After Dilution
RT
24 hours
Solution should not be refrigerated.
INCOMPATIBILITY -
REMARKS For intravenous infusion over at least 1 hour to prevent renal tubular damage
Reference : 4. PRODUCT LEAFLET: Vaxcel Acyclovir Kontra Pharma.
1.0 ACYCLOVIR INJECTION
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Antimicrobial Dilution Protocol (AmDP)
2.1 BRAND : Eraxis ®
STRENGTH 100mg powder
RECONSTITUTION/ DILUTION
IV: For 100mg: Reconstitute with 30ml WFI Further dilute with 100ml NS/ D5 For 200mg: Reconstitute with 60ml WFI Further dilute with 200ml NS/ D5
ADMINISTRATION
IV: Rate of infusion: Should not exceed 1.1mg/min (equivalent 1.4 ml/min for both 100mg and 200mg doses)
Dose Minimum Duration of Infusion
100mg 90 minutes
200mg 180 minutes
STABILITY
-This medication must be kept in fridge at 2 - 8°C
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
24 hours NA 48 hours NA
INCOMPATIBILITY -
REMARKS -
Reference :
5. PRODUCT LEAFLET : Eraxis, Pfizer.
2.0 ANIDULAFUNGIN INJECTION
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Antimicrobial Dilution Protocol (AmDP)
3.1 BRAND : Apalin ®
STRENGTH 500mg in 2ml
RECONSTITUTION/ DILUTION
IM: Inject directly IV infusion: Add to 100 to 200ml NS/ D5 (Maximum concentration: 5mg/ml)
ADMINISTRATION IM IV Infusion over 30 - 60 minute period
STABILITY
At concentration of 0.25mg/ml and 5mg/ml
After Reconstitution After Dilution
RT 2 - 8°C RT 4°C -15°C (frozen)
Information not available (recommend to use
immediately)
24 hours
60 days 30 days
INCOMPATIBILITY -
REMARKS Solutions may vary in color from colorless to light straw or very pale yellow. Discard dark-colored solutions
Reference : 6. PRODUCT LEAFLET : Apalin, CCM Duopharma Bio Tech.
3.0 AMIKACIN INJECTION
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Antimicrobial Dilution Protocol (AmDP)
3.2 BRAND : Selemycin ®
STRENGTH 500ml in 2ml
RECONSTITUTION/ DILUTION
IM: Inject directly IV Infusion: Add into 100 - 200ml NS/ D5 (Maximum concentration: 5mg/ml)
ADMINISTRATION IV infusion over 30 - 60 minutes
STABILITY
At concentration of 0.25mg/ml and 5mg/ml
After Reconstitution After Dilution
RT 2 - 8°C RT 4°C
Information not available (recommend
to use immediately)
24 hours 60 days
INCOMPATIBILITY -
REMARKS Do not freeze
Reference : 7. PRODUCT LEAFLET : Selemycin Medochemie Ltd, Cyprus.
3.0 AMIKACIN INJECTION
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Antimicrobial Dilution Protocol (AmDP)
4.1 BRAND : Augmentin Intravenous ®
STRENGTH 600mg powder 1.2g powder
RECONSTITUTION/ DILUTION
Slow IV injection: i) 600mg vial: Reconstitute with 10ml WFI (Final Volume 10.5ml) ii) 1.2g vial: Reconstitute with 20ml WFI (Final Volume 20.9ml) IV infusion: i) 600mg vial: Reconstitute with10ml WFI Further dilute with 50ml WFI/ NS ii) 1.2g vial: Reconstitute with 20ml WFI Further dilute with 100ml WFI/ NS
ADMINISTRATION Slow IV bolus over 3 – 4 minutes IV infusion over 30 - 40 minutes
STABILITY
REFREGIRATED RECONSTITUTED SOLUTION MUST IMMEDIATELY USED ONCE REACHING ROOM TEMPERATURE
After Reconstitution After Dilution
RT 2 - 8°C RT
20 minutes - 4 hours
INCOMPATIBILITY
Should not be mixed with blood products, proteinaceous fluids (e.g. protein hydrolysates and or IV lipid emulsions Should not be administered concurrently with aminoglycosides in syringe, IV fluid container or giving set as it may cause loss of aminoglycosides activity
REMARKS It is less stable in infusion containing glucose, dextran or bicarbonate (Do not add to such solutions)
Reference : 8. PRODUCT LEAFLET : Augmentin Intravenous GlaxoSmithKline
4.0 AMOXYCILLIN/ CLAVULANATE INJECTION
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Antimicrobial Dilution Protocol (AmDP)
4.2 BRAND : Clamentin Injection ®
STRENGTH 1.2g powder
RECONSTITUTION/ DILUTION
IV: Add 20ml of WFI IV Infusion: Add 20ml of WFI Further dilute to 100ml WFI/ NS
ADMINISTRATION Slow IV bolus over 3 - 4 minutes IV Infusion over 30 - 40 minutes
STABILITY
If use WFI as diluent:-
If use NS as diluent: -
After Reconstitution After Dilution
RT 2 - 8°C RT
10 minutes - 4 hours
After Reconstitution After Dilution
RT 2 - 8°C RT
- - 4 hours
INCOMPATIBILITY
Should not be mixed with blood products, proteinaceous fluids (e.g. protein hydrolysates and or IV lipid emulsions Should not be administered concurrently with aminoglycosides in syringe, IV fluid container or giving set as it may cause loss of aminoglycosides activity
REMARKS
It is less stable in infusion containing glucose, dextran or bicarbonate (Do not add to such solutions) Appearance: White to off white powder in vial. Solution will be a colorless to pale yellow liquid in vial without other foreign matter
Reference : 9. PRODUCT LEAFLET : Clamentin Injection, Yung Shin Pharmaceutical Ind. Co., Ltd.
4.0 AMOXYCILLIN/ CLAVULANATE INJECTION
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Antimicrobial Dilution Protocol (AmDP)
4.3 BRAND : Co-Amoxiclav Injection ®
STRENGTH 1.2g powder
RECONSTITUTION/ DILUTION
IV : Add 20ml of WFI IV infusion: Add 20ml of WFI Further dilute with 100ml WFI/ NS
ADMINISTRATION
Slow IV bolus over 3 - 4 minutes IV Infusion over 30 - 40 minutes
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY
Should not be mixed with blood products, proteinaceous fluids (e.g. protein hydrolysates and or IV lipid emulsions) Should not be administered concurrently with aminoglycosides in syringe, IV fluid container or giving set as it may cause loss of aminoglycosides activity
REMARKS
It is less stable in infusion containing glucose, dextran or bicarbonate (Do not add to such solutions) Appearance: Sterile Powder for injection A transient pink coloration may appear during reconstitution. Upon completion may appear colorless or pale straw color
Reference : 10. PRODUCT LEAFLET : Co-Amoxiclav Injection Averroes Pharmaceuticals Sdn Bhd.
4.0 AMOXYCILLIN/ CLAVULANATE INJECTION
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Antimicrobial Dilution Protocol (AmDP)
5.1 Ampicillin Sodium for Injection BP ®
STRENGTH 500mg powder
RECONSTITUTION/ DILUTION
IM: Reconstitute with 1.5ml of WFI IV: Reconstitute with 10ml of WFI
ADMINISTRATION IM Slow IV bolus over 3 - 4 minutes
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY
Not to be administer concurrently with beta-lactam antibacterials and aminoglycosides. If administered concurrently, separate sites at least 1 hour.
REMARKS -
Reference : 11. PRODUCT LEAFLET : Ampicillin Sodium for Injection B, Karnataka Antibiotics &
Pharmaceuticals Limited, India; July 2009.
5.0 AMPICILIN INJECTION
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Antimicrobial Dilution Protocol (AmDP)
5.2 BRAND : Pamecil®
STRENGTH 500mg powder
RECONSTITUTION/ DILUTION
IM: Reconstitute with 1.8ml of WFI IV: Reconstitute with 5ml of WFI (for 500 mg dose) Reconstitute with 7.4ml of WFI (for 1 g dose)
ADMINISTRATION
IM Slow IV bolus over 3 – 5 minutes (for 250 – 500 mg dose) Slow IV bolus over 10 – 15 minutes (for 1 g dose)
STABILITY Use immediately after reconstitution.
INCOMPATIBILITY -
REMARKS -
Reference :
12. PRODUCT LEAFLET : Pamecil, Medochemie Ltd, Selangor.
5.0 AMPICILLIN INJECTION
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Antimicrobial Dilution Protocol (AmDP)
5.3 BRAND : Standacillin ®
STRENGTH 500mg powder
RECONSTITUTION/ DILUTION
IM: Reconstitute with 5ml of WFI IV Infusion: Reconstitute with 5ml of WFI, Further dilute with 50 - 500ml of NS
ADMINISTRATION
IM Slow IV bolus over 3 - 5 minutes IV infusion over 15 - 20 minutes
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY -
REMARKS -
Reference :
13. PRODUCT LEAFLET : Standacillin, Sandoz.
5.0 AMPICILLIN INJECTION
18
Antimicrobial Dilution Protocol (AmDP)
6.1 BRAND : Ampicillin & Sulbactam powder for injection ®
STRENGTH 1.5g powder
RECONSTITUTION/ DILUTION
IV/ IM: Reconstitute with 3.2 ml WFI IV Infusion: Further dilute to 50 – 500 ml of NS
ADMINISTRATION
IM: Deep IM injection Slow IV Bolus over 3 - 4 minutes IV Infusion over 15 - 30 minutes
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY -
REMARKS -
Reference : 14. PRODUCT LEAFLET : Ampicillin & Sulbactam powder for injection Karnataka
Antibiotics & Pharmaceuticals Limited, India; August 2010.
6.0 AMPICILLIN/ SULBACTAM INJECTION
19
Antimicrobial Dilution Protocol (AmDP)
6.2 BRAND : Sulbacin ®
STRENGTH 1.5g powder
RECONSTITUTION/ DILUTION
IM: Reconstitute with 3ml of WFI IV : Reconstitute with 5ml of WFI IV Infusion: Reconstitute with 5ml of WFI, further dilute with 50 - 100ml NS
ADMINISTRATION
IM: Deep IM injection Slow IV bolus over 10 -15 minutes IV infusion over 15 - 30 minutes
STABILITY
After Reconstitution After Dilution
RT 4°C Information not available (recommend to use
immediately)
8 hours 72 hours
INCOMPATIBILITY -
REMARKS -
Reference : 15. PRODUCT LEAFLET : Sulbacin, Unichem.
6.0 AMPICILLIN/ SULBACTAM INJECTION
20
Antimicrobial Dilution Protocol (AmDP)
7.1 BRAND : Amphotret ®
STRENGTH 50mg powder
RECONSTITUTION/ DILUTION
IV: Reconstitute with 10ml of WFI , Further dilute with 500ml D5 ( dose <50mg) or 1000ml (for dose > 50mg) Maximum concentration of 0.1mg/ml
ADMINISTRATION Slow infusion over 2 - 6 hours
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C Use immediately after dilution 24 hours 7days
INCOMPATIBILITY -
REMARKS
If test dose is needed: Test dose: 1mg (0.2ml) further dilute in 20ml of D5, administer over 20-30 minutes
1. Monitor patient’s temperature, pulse, respiration rate &
blood pressure every 30 minutes for 2 - 4hours 2. Infusion related immediate reaction may happen with
chills, fever, hypotension, nausea or anaphylactic reaction. Premedication (Paracetamol, Hydrocortisone/ Chlorpheniramine) given 30 minutes prior to administration
3. Prophylactic antipyretics or hydrocortisone should only
be used in patients who have previously experienced acute adverse reactions
References : 16. PRODUCT LEAFLET : Amphotret Bharat Serums And Vaccines Ltd. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,
Greenwood Village, Colorado, USA.
7.0 AMPHOTERICIN B INJECTION
21
Antimicrobial Dilution Protocol (AmDP)
8.1 BRAND : Artesun ®
STRENGTH 60mg powder
RECONSTITUTION/ DILUTION
IM: Reconstitute with 1ml of 5% sodium bicarbonate solution, Further dilute with 2 ml of NS/ D5 IV: Reconstitute with 1ml of 5% sodium bicarbonate solution, Further dilute with 5ml of NS/ D5
ADMINISTRATION IM Slow IV bolus (3 - 4 ml/min)
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY -
REMARKS -
Reference : 17. PRODUCT LEAFLET : Artesun, Guilin Pharmaceutical Co Ltd.
8.0 ARTESUNATE INJECTION
22
Antimicrobial Dilution Protocol (AmDP)
9.1 BRAND : Azee ® 9.2 BRAND : Zitromax ® (Brands above have same information)
STRENGTH 500mg powder
RECONSTITUTION/ DILUTION
IV: Reconstitute with 4.8ml of WFI Further dilute with 250 - 500ml of NS/D5
ADMINISTRATION IV infusion 1mg/ml over 3 hrs (500ml infusion)
IV infusion 2mg/ml over 1 hr (250ml infusion)
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
Information not available (recommend
to use immediately)
24 hours 7 Days (only for brand Zithromax®)
INCOMPATIBILITY -
REMARKS -
References : 18. PRODUCT LEAFLET : Azee, Cipla United. 19. PRODUCT LEAFLET : Zitromax, Pfizer. 105. Injectable Drugs Dilution 2010, Bahagian Perkhidmatan Farmasi Perak. 106. Guidelines on Reconstitution & Administration of Injectable Drugs. 2013, Hospital
Kuala Lipis.
9.0 AZITHROMYCIN INJECTION
23
Antimicrobial Dilution Protocol (AmDP)
10.1 BRAND : Retarpen ®
STRENGTH 1.8g powder
RECONSTITUTION/ DILUTION
Reconstitute with 5ml of WFI
ADMINISTRATION IM only
STABILITY Use immediately after reconstitution
INCOMPATIBILITY -
REMARKS -
References : 20. PRODUCT LEAFLET : Retarpen, Sandoz. 100. MIMS Online; http://online1.mimsgateway.com.my. 106. Guidelines on Reconstitution & Administration of Injectable Drugs. 2013, Hospital
Kuala Lipis.
10.0 BENZATHINE PENICILLIN INJECTION
24
Antimicrobial Dilution Protocol (AmDP)
11.1 BRAND : Penicilin G Sodium Sandoz ®
STRENGTH
One million unit powder (600mg)
Five million unit powder (3g)
RECONSTITUTION/ DILUTION
IM : Reconstitute with 5 - 10ml WFI (apply to not more than 6g of dose)
IV injection/IV Infusion : 600mg vial: Reconstitute with 10ml WFI 3g vial: Reconstitute with 50ml of WFI
ADMINISTRATION IM : Up to 5ml of injectable solution per injection site IV : Information not provided
STABILITY
Use immediately after reconstitution and preparation Penicillin G rapidly disintegrate even at refrigerated temperature
INCOMPATIBILITY
Solutions contain metal ions, oxidating and reducing substances, alcohol, glycerol, macrogols and other hydroxyl compounds. Sympathomimetic amines, Dextrose, Tetracycline
REMARKS Ringer’s lactate or other solutions containing sodium should not be used to avoid electrolyte imbalance to reconstitute the solution
Reference :
52. PRODUCT LEAFLET : Penicilin G Sodium Sandoz, Sandoz GmbH
11.0 BENZYLPENICILLIN INJECTION
25
Antimicrobial Dilution Protocol (AmDP)
11.2 BRAND : Benzyl Penicillin For Injection ®
STRENGTH One million unit powder (600mg) Five million unit powder (3g)
RECONSTITUTION/ DILUTION
600mg vial: Reconstitute with 2ml or more of WFI 3g vial: Reconstitute with 10ml or more of WFI
ADMINISTRATION IM : Up to 5ml of injectable solution IV infusion: over 1 hour (1ml/min)
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
2 days 6 days - -
INCOMPATIBILITY
Solutions contain metal ions should be administered separately Should not be administered in the same syringe / giving set as Amphotericin B, Cimetidine, Cytarabine, Flucloxacillin, Hydroxyzine, Methylprednisolone or Promethazine
REMARKS -
Reference :
53. PRODUCT LEAFLET : Benzyl Penicillin For Injection, Karnataka Antibiotics & Pharmaceuticals Ltd.
11.0 BENZYLPENICILLIN INJECTION
26
Antimicrobial Dilution Protocol (AmDP)
12.1 BRAND : Cancidas ®
STRENGTH 50mg powder 70mg powder
RECONSTITUTION/ DILUTION
Let refrigerated Caspofungin to room temperature before reconstitution. Reconstitute with 10.8 ml of NS or WFI
i) For 70mg (loading dose): Withdraw two separate 5 ml solution and add to two separate 100ml NS
ii) For 50mg : Take 10ml solution and dilute in 100ml NS
ADMINISTRATION
i) For 70mg (loading dose): Infuse first IV bag for 30 minutes followed by second IV bag for another 30 minutes
ii) For 50mg :Slow IV infusion over 1 hour
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
1 hour - 24 hours 48 hours
INCOMPATIBILITY Diluents containing dextrose
REMARKS Dilution of 70mg in single 100ml IV bag not recommended Final concentration should not exceed 0.5mg/ml
References : 22. PRODUCT LEAFLET : Cancidas, Merck Sharp & Dohme. 100. MIMS Online; http://online1.mimsgateway.com.my.
12.0 CASPOFUNGIN INJECTION
27
Antimicrobial Dilution Protocol (AmDP)
13.1 BRAND : Cefazolin Sandoz ® 13.2 BRAND : Reflin ® (Brands above have same information))
STRENGTH 1g powder
RECONSTITUTION/ DILUTION
IM: Reconstitute with 2.5ml of WFI IV: Reconstitute with 4ml WFI/ NS
IV infusion: Further dilute with 50 – 100ml NS
ADMINISTRATION Dose ≤ 1g: IM or slow infusion over 3 - 5 minutes
Dose > 1g: Infusion over 20 - 30 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
- 24 hours Information not available (recommend to use
immediately)
INCOMPATIBILITY -
REMARKS -
References : 23. PRODUCT LEAFLET : Cefazolin Sandoz. 24. PRODUCT LEAFLET : Reflin, Ranbaxy. 100. MIMS Online; http://online1.mimsgateway.com.my.
13.0 CEFAZOLIN INJECTION
28
Antimicrobial Dilution Protocol (AmDP)
14.1 BRAND : Verapime ®
STRENGTH 1g powder
RECONSTITUTION / DILUTION
IM : Reconstitute with 3ml of WFI or 1% Lidocaine IV: Reconstitute with 10ml of NS/ D5 Further dilute to 50 -100ml with NS/ D5
ADMINISTRATION
IM Slow IV bolus over 3 - 5 minutes
IV infusion over 30 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
12 hours 24 hours Information not available (recommend to use
immediately)
INCOMPATIBILITY
Should not administered concurrently with Ampicillin (<40mg/mL), Aminophylline, Gentamicin, Metronidazole, Netilmicin, Tobramycin or Vancomycin If administer concurrently, should use separate site
REMARKS -
References : 25. PRODUCT LEAFLET : Verapime, Demo S.A Pharmaceutical Industry. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,
Greenwood Village, Colorado, USA. 101. Drug Information Handbook. 23rd ed. Vol. 2014-2015: Hudson, Ohio, Lexi-Comp, Inc.
14.0 CEFEPIME INJECTION
29
Antimicrobial Dilution Protocol (AmDP)
14.2 BRAND : Vaxcel Cefepime ®
STRENGTH 1g powder
RECONSTITUTION / DILUTION
IM : i) 500mg injection : Reconstitute with 1.5ml of WFI/ NS/ D5
ii)1g injection : Reconstitute with 3ml of WFI/ NS/ D5
IV : i) 500mg injection : Reconstitute with 5ml of WFI /NS/ D5 ii) 1g injection : Reconstitute with 10ml of WFI/ NS/ D5
Further dilute to 50 - 100ml with WFI/ NS/ D5
ADMINISTRATION
IM Slow IV bolus over 3 - 5 minutes
IV infusion over 30 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
24 hours 7 days 24 hours 7 days
INCOMPATIBILITY
Should not administered concurrently with Ampicillin (< 40mg/mL), Aminophylline, Gentamicin, Metronidazole, Netilmicin, Tobramycin or Vancomycin If administer concurrently, should use separate site
REMARKS -
References : 26. PRODUCT LEAFLET : Vaxcel Cefepime Kotra Pharma (M) Sdn. Bhd. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,
Greenwood Village, Colorado, USA. 101. Drug Information Handbook. 23rd ed. Vol. 2014-2015: Hudson, Ohio, Lexi-Comp, Inc.
14.0 CEFEPIME INJECTION
30
Antimicrobial Dilution Protocol (AmDP)
14.3 BRAND : Forpar ®
STRENGTH 1g powder
RECONSTITUTION / DILUTION
IM : Reconstitute with 2.4ml of NS/ D5 IV : Reconstitute with 10ml of NS/ D5 Further dilute to 50 - 100ml with NS
ADMINISTRATION
IM Slow IV bolus over 3 - 5 minutes IV infusion over 30 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
24 hours 7 days 24 hours 7 days
INCOMPATIBILITY
Should not administered concurrently with Ampicillin (< 40mg/mL), Aminophylline, Gentamicin, Metronidazole, Netilmicin, Tobramycin or Vancomycin If administer concurrently, should use separate site
REMARKS -
Reference : 27. PRODUCT LEAFLET : Forpar, Cipla (M) Sdn. Bhd. 2014.
14.0 CEFEPIME INJECTION
31
Antimicrobial Dilution Protocol (AmDP)
14.4 BRAND : Megapime ®
STRENGTH 500mg powder 1g powder
RECONSTITUTION / DILUTION
IM : i) 500mg : Reconstitute with 1.5ml of NS/ D5 ii)1g : Reconstitute with 3ml of NS/ D5 IV : i) 500mg : Reconstitute with 5ml of NS/ D5 ii)1g : Reconstitute with 10ml of NS/ D5 Further dilute to 50 -100ml with NS/ D5
ADMINISTRATION
IM Slow IV bolus over 3 - 5 minutes IV infusion over approximately 30 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
24 hours 7 days 24 hours 7 days
INCOMPATIBILITY
Should not administered concurrently with Ampicillin (<40mg/mL), Aminophylline, Gentamicin, Metronidazole, Netilmicin, Tobramycin or Vancomycin If administer concurrently, should use separate site
REMARKS Concomitant administration with Probenecid prolongs renal tubular secretion of Cefepime, resulting high serum concentration
Reference : 28. PRODUCT LEAFLET : Megapime, Alkem Lab Ltd. 2006.
14.0 CEFEPIME INJECTION
32
Antimicrobial Dilution Protocol (AmDP)
14.5 BRAND : Sefepim ®
STRENGTH 1g powder
RECONSTITUTION / DILUTION
IM : Reconstitute 1g with 3ml of NS/ D5 IV : Reconstitute 1g with 10ml of NS/ D5 Further dilute with 50-100ml NS/ D5
ADMINISTRATION
IM Slow IV bolus over 3 - 5 minutes IV infusion over approximately 30 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
24 hours 7 days 24 hours 7 days
INCOMPATIBILITY
Should not administered concurrently with Ampicillin (<40mg/mL), Aminophylline, Gentamicin, Metronidazole, Netilmicin, Tobramycin or Vancomycin. If administer concurrently, should use separate site
REMARKS IV route is preferable for severe/ life-threatening infection, particularly if shock is present
Reference : 29. PRODUCT LEAFLET : Sefepim, Hovid Sdn Bhd. 2014.
14.0 CEFEPIME INJECTION
33
Antimicrobial Dilution Protocol (AmDP)
15.1 BRAND : Rekaxime ®
STRENGTH 500mg powder 1g powder
RECONSTITUTION / DILUTION
IM : i) 500mg : Reconstitute with 2ml of WFI ii)1g : Reconstitute with 4ml of WFI IV : i) 500mg : Reconstitute with 2ml of WFI ii)1g : Reconstitute with 4ml of WFI iii)2g : Reconstitute with 10ml of WFI Short infusion : Further dilute with 2g in 40ml of NS/ D10 Continuous drip : Further dilute 2g vial in 100ml of NS/ D10
ADMINISTRATION
IM Slow IV bolus over 3 - 5 minutes Infusion Short infusion over 20 minutes Continuous drip over 50 - 60 minutes
STABILITY To be used immediately
INCOMPATIBILITY -
REMARKS/* If daily dose exceeds 2g, IV injection is preferred
Reference : 30. PRODUCT LEAFLET : Rekaxime, Duopharma (M) Sdn Bhd. 2011.
15.0 CEFOTAXIME INJECTION
34
Antimicrobial Dilution Protocol (AmDP)
15.2 BRAND : Claraxim ®
STRENGTH 500mg powder 1g powder
RECONSTITUTION / DILUTION
IM : 1g : Reconstitute with 4ml of WFI (Can further dilute with 4ml of 1% Lidocaine to avoid pain) IV i) 250mg & 500mg : Reconstitute with 2ml of WFI ii) 1g : Reconstitute with 4ml of WFI iii) 2g : Reconstitute with 10ml of WFI Short infusion: further dilute 2g in 40ml of NS/ D10 Continuous drip: further dilute 2g in 100ml of NS/ D10
ADMINISTRATION
IM Slow IV bolus over 3 - 5 minutes Infusion Short infusion over 20 minutes Continuous drip over 50 - 60 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
- 24 hours Information not available (recommend to use
immediately)
INCOMPATIBILITY -
REMARKS If daily dose exceeds 2g or Claraxim 1g is administered more than twice daily, IV injection is preferred
Reference : 31. PRODUCT LEAFLET : Claraxim, Siam Bheasach Co. Ltd. 2006.
15.0 CEFOTAXIME INJECTION
35
Antimicrobial Dilution Protocol (AmDP)
15.3 BRAND : Claforan ®
STRENGTH 500mg powder 1g powder
RECONSTITUTION / DILUTION
IM : 1g : Reconstitute with 4ml of WFI Further dilute with corresponding amount* of 1% Lidocaine IV : i) 500mg : Reconstitute with 2ml of WFI ii) 1g : Reconstitute with 4ml of WFI iii)2g : Reconstitute with 10ml of WFI Short infusion: further dilute 2g in 40ml of NS/ D10 Continuous drip: further dilute 2g in 100ml of NS/ D10
ADMINISTRATION
IM Slow IV bolus over 3 - 5 minutes Infusion Short infusion over approximately 20 minutes Continuous drip over 50 - 60 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
12 hours 24 hours 12 hours 24 hours
INCOMPATIBILITY -
REMARKS Intravenous injection is recommended if the daily dose exceeds 2 g or if Claforan 1 g is administered more than twice daily
* Suitable volume of Lidocaine to avoid pain during IM injection
Reference : 32. PRODUCT LEAFLET : Claforan, Aventis Pharma.
15.0 CEFOTAXIME INJECTION
36
Antimicrobial Dilution Protocol (AmDP)
15.4 BRAND : Vaxcel Cefotaxime ®
STRENGTH 500mg powder 1g powder
RECONSTITUTION / DILUTION
IM : 1g : Reconstitute with 4ml of WFI Further dilute with corresponding amount* of 1% Lidocaine IV : i) 1g : Reconstitute with 4ml of WFI ii) 2g : Reconstitute with 10ml of WFI Short infusion: further dilute 2g in 40ml of NS/ D10 Continuous drip: further dilute 2g in 100ml of NS/ D10
ADMINISTRATION
IM Slow IV bolus over 3 - 5 minutes IV Infusion Short infusion over approximately 20 minutes Continuous drip over 50 - 60 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
24 hours - Information not available (recommend to use
immediately)
INCOMPATIBILITY -
REMARKS Intravenous injection is recommended if the daily dose exceeds 2g or if Cefotaxime 1g is administered more than twice daily
* Suitable volume of Lidocaine to avoid pain during IM injection
Reference : 33. PRODUCT LEAFLET : Vaxcel Cefotaxime, Kotra Pharma (M) Sdn.Bhd.
15.0 CEFOTAXIME INJECTION
37
Antimicrobial Dilution Protocol (AmDP)
16.1 BRAND : Bicafar ® 16.2 BRAND : Vaxcel Cefoperazone ® (Brands above have same information)
STRENGTH 500mg powder 1g powder 2g powder
RECONSTITUTION/ DILUTION
IM i) 500mg : Reconstitute with 1.3ml of WFI ii) 1g : Reconstitute with 2.6ml of WFI iii) 2g : Reconstitute with 5.2ml of WFI Further dilute i) 500mg : add 0.4ml of 2% Lidocaine ii) 1g : add 0.9ml of 2% Lidocaine iii) 2g : add 1.8ml of 2% Lidocaine Slow IV Bolus dilute with WFI/NS/D5, final concentration 100mg/ml IV 1g & 2g : Reconstitute with 5ml of WFI/ NS/ D5 Further dilute with 20 -100ml of WFI/ NS/ D5
ADMINISTRATION
IM Slow IV bolus over 3 - 5 minutes. IV Infusion over 15 - 60 minutes
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY -
REMARKS -
References : 34. PRODUCT LEAFLET : Bicafar, Duopharma (M) Sdn Bhd. 2012. 35. PRODUCT LEAFLET : Vaxcel Cefoperazone, Kotra Pharma (M) Sdn.Bhd.
16.0 CEFOPERAZONE INJECTION
38
Antimicrobial Dilution Protocol (AmDP)
17.1 BRAND : Vaxcel Cefobactam ®
STRENGTH 1g powder
RECONSTITUTION/ DILUTION
IV : 1g : Reconstitute with 3.4ml of NS/ D5/ WFI Further dilute with 20ml NS/ D5/ WFI
ADMINISTRATION Slow IV bolus over of 3 minutes IV Infusion: over 15 - 60 minutes
STABILITY
Dilute in D5 : Use immediately
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
24 hours NA Information not available
(recommend to use immediately)
INCOMPATIBILITY Should not be directly mixed with aminoglycoside due to physical incompatibility.
REMARKS -
Reference : 36. PRODUCT LEAFLET : Vaxcel Cefobactam, Kotra Pharma (M) Sdn.Bhd.
17.0 CEFOPERAZONE/ SULBACTAM INJECTION
39
Antimicrobial Dilution Protocol (AmDP)
17.2 BRAND : Cefper ®
STRENGTH 1g powder
RECONSTITUTION/ DILUTION
IV : 1g : Reconstitute with WFI to volume of 4ml Further dilute to 20ml with WFI
ADMINISTRATION Slow IV bolus over 3 minutes IV Infusion over 15 - 60 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
24 hours 5 days Information not available (recommend to use
immediately)
INCOMPATIBILITY -
REMARKS -
Reference : 37. PRODUCT LEAFLET : Cefper Biolab Co. LTD, 2009.
17.0 CEFOPERAZONE/ SULBACTAM INJECTION
40
Antimicrobial Dilution Protocol (AmDP)
17.3 BRAND : Cefoperazone & Sulbactam 1.0g
STRENGTH 1g powder
RECONSTITUTION/ DILUTION
IV : 1g : Reconstitute with 3.4ml of NS/ D5/ WFI Further dilute with 20ml NS/ D5/ WFI
ADMINISTRATION Slow IV bolus over of 3 minutes IV Infusion over 15 - 60 minutes
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY -
REMARKS -
Reference :
38. PRODUCT LEAFLET : Cefoperazone & Sulbactam 1.0G, Karnataka Antibiotics & Pharmaceuticals Limited, 2010.
17.0 CEFOPERAZONE/ SULBACTAM INJECTION
41
Antimicrobial Dilution Protocol (AmDP)
18.1 BRAND : Zinforo ®
STRENGTH 600mg powder
RECONSTITUTION/ DILUTION
IV : Reconstitute with 20ml of WFI
Further dilute with 50ml - 250ml NS/ D5
ADMINISTRATION Infusion over 1 hour
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
Use immediately
NA 6 hours 24 hours
INCOMPATIBILITY -
REMARKS Protect from light
Reference : 39. PRODUCT LEAFLET : Zinforo, Facta Farmaceutici S.p.A, October 2012.
18.0 CEFTAROLINE INJECTION
42
Antimicrobial Dilution Protocol (AmDP)
19.1 BRAND : Cefatum ®
STRENGTH 1g powder 2g powder
RECONSTITUTION/ DILUTION
IM : Reconstitute with 3ml of 0.5% lignocaine HCl
IV : Reconstitute with 10ml of WFI
IV infusion : Further dilute with 50 - 500ml NS/ D5
ADMINISTRATION
IM Slow IV bolus over 3 - 5 minutes
IV infusion over 30 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
WFI- 12 hours 0.5% Lignocaine HCl- 6 hours
WFI- 7 days 0.5% Lignocaine HCl- 4 days
12 hours 7 days
INCOMPATIBILITY -
REMARKS -
Reference : 40. PRODUCT LEAFLET : Cefatum, Duopharma (M) Sdn Bhd, 6 August 2010.
19.0 CEFTAZIDIME INJECTION
43
Antimicrobial Dilution Protocol (AmDP)
19.2 BRAND : Fortum ®
STRENGTH 1g powder 2g powder
RECONSTITUTION/ DILUTION
IM : Reconstitute with 3ml of 0.5% lignocaine HCl
IV : Reconstitute with 10ml of WFI
Further dilute with 50 - 500ml NS/ D5
ADMINISTRATION
IM Slow IV bolus over 3 - 5 minutes
IV infusion over 30 minutes
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY -
REMARKS -
References : 41. PRODUCT LEAFLET : Fortum, GlaxoSmithKline. 100. MIMS Online; http://online1.mimsgateway.com.my.
19.0 CEFTAZIDIME INJECTION
44
Antimicrobial Dilution Protocol (AmDP)
20.1 BRAND : Unocef ®
STRENGTH 250mg powder 500mg powder 1g powder
RECONSTITUTION/ DILUTION
IM : 250mg: Reconstitute with 0.9ml of WFI/ NS/ D5
500mg: Reconstitute with 1.8ml of WFI/ NS/ D5
1g : Reconstitute with 3.6ml of WFI/ NS/ D5
IV infusion : 250mg: Reconstitute with 2.4ml of WFI
500mg: Reconstitute with 4.8ml of WFI
1g : Reconstitute with 9.6ml of WFI
Further dilute with 50 - 100ml NS/ D5
ADMINISTRATION IV infusion over 30 minutes
STABILITY
i) For IM :
Diluent Concentration (mg/ml)
After reconstitution
RT 2 - 8°C
WFI 100
250, 350
3 days
24 hours
10 days
3 days
NS 100
250, 350
3 days
24 hours
10 days
3 days
D5 100
250, 350
3 days
24 hours
10 days
3 days
ii) For IV :
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
3 days 10 days 3 days 10 days
INCOMPATIBILITY -
REMARKS -
Reference : 42. PRODUCT LEAFLET : Unocef, Duopharma (M) Sdn Bhd, 27 July 2010.
20.0 CEFTRIAXONE INJECTION
45
Antimicrobial Dilution Protocol (AmDP)
20.2 BRAND : Rocephin ®
STRENGTH 250mg powder 500mg powder 1g powder
RECONSTITUTION/ DILUTION
IM : 500mg: Reconstitute with 1.8ml of WFI/ NS/ D5
1g : Reconstitute with 3.6ml of WFI/ NS/ D5
IV infusion : 500mg:Reconstitute with 4.8ml of WFI
1g : Reconstitute with 9.6ml of WFI
Further dilute with 50 - 100ml NS/ D5
ADMINISTRATION IV infusion over 30 minutes
STABILITY
i) For IM :
Diluent Concentration (mg/ml)
Storage
RT 2 - 8°C
WFI 100
250, 350
2 days
24 hours
10 days
3 days
NS 100
250, 350
2 days
24 hours
10 days
3 days
D5 100
250, 350
2 days
24 hours
10 days
3 days
ii) For IV :
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
2 days 10 days 2 days 10 days
INCOMPATIBILITY -
REMARKS -
Reference : 43. PRODUCT LEAFLET : Rocephin, Roche.
20.0 CEFTRIAXONE INJECTION
46
Antimicrobial Dilution Protocol (AmDP)
21.1 BRAND : Zinacef ®
STRENGTH 750mg powder 1.5g powder
RECONSTITUTION/ DILUTION
IM : 750mg : Reconstitute with 3ml of WFI
IV : 750mg: Reconstitute with 6ml of WFI
1.5g : Reconstitute with 15ml of WFI
Further dilute with 50 -100ml NS/ D5
ADMINISTRATION
IM
Slow IV bolus over 3 - 5 minutes
IV infusion over 30 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
5 hours 48 hours Information not available (recommend to use
immediately)
INCOMPATIBILITY -
REMARKS -
References : 44. PRODUCT LEAFLET : Zinacef, GlaxoSmithKline.
100. MIMS Online; http://online1.mimsgateway.com.my.
21.0 CEFUROXIME INJECTION
47
Antimicrobial Dilution Protocol (AmDP)
21.2 BRAND : Anikef ®
STRENGTH 750mg powder 1.5g powder
RECONSTITUTION/ DILUTION
IM : 250mg : Reconstitute with 1ml of WFI
750mg : Reconstitute with 3ml of WFI
IV : 250mg : Reconstitute with 2ml of WFI
750mg : Reconstitute with 6ml of WFI
1.5g : Reconstitute with 15-50ml of WFI
ADMINISTRATION IM
Slow IV bolus over 3 - 5 minutes
IV infusion over 30 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
5 hours 48 hours Information not available (recommend to use
immediately)
INCOMPATIBILITY -
REMARKS -
Reference : 45. PRODUCT LEAFLET : Anikef Duopharma (M) Sdn Bhd, 2 September 2013.
21.0 CEFUROXIME INJECTION
48
Antimicrobial Dilution Protocol (AmDP)
22.1 BRAND : Ciproxol ®
STRENGTH 200mg in 100ml
RECONSTITUTION/ DILUTION
Ready to use solution
ADMINISTRATION IV infusion over 60 minutes
STABILITY Remaining solution should be discarded.
INCOMPATIBILITY -
REMARKS Protect from light Do not refrigerate
Reference :
46. PRODUCT LEAFLET : Ciproxol Ain Medicare Sdn. Bhd.
22.0 CIPROFLOXACIN INJECTION
49
Antimicrobial Dilution Protocol (AmDP)
22.2 BRAND : Ciprobay ®
22.3 BRAND : Ufexil ®
(Brands above have same information)
STRENGTH 200mg in 100ml
RECONSTITUTION/ DILUTION
Ready to use solution
ADMINISTRATION IV infusion over 60 minutes
STABILITY Remaining solution should be discarded.
INCOMPATIBILITY Heparin, penicillins
REMARKS Inspect for particulate matters and discoloration prior to administration. Only clear and colourless or slightly yellow solution can be used
References :
47. PRODUCT LEAFLET : Ciprobay, Bayer Co. (Malaysia) Sdn Bhd. 48. PRODUCT LEAFLET : Ufexil DEMO S.A.
22.0 CIPROFLOXACIN INJECTION
50
Antimicrobial Dilution Protocol (AmDP)
23.1 BRAND : Dalacin C ®
STRENGTH 300mg in 2ml
RECONSTITUTION/ DILUTION
IM : Inject directly IV infusion : Final diluted concentration must be ≤18mg/ml
i) 300mg : Reconstitute with 50ml NS ii) 600mg : Reconstitute with 100ml NS iii) 900mg : Reconstitute with 150ml NS iv) 1200mg: Reconstitute with 200ml NS
ADMINISTRATION
IM : ONLY for dose ≤600mg IV Infusion :
i) Dose of 300mg : over 10 minutes ii) Dose of 600mg : over 20 minutes iii) Dose of 900mg : over 30 minutes iv) Dose of 1200mg: over 45 minutes
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY Ampicillin, Phenytoin Sodium, Diphenyldantoin, Barbiturates, Aminophylline, Calcium Gluconate, Magnesium Sulphate, Ceftriaxone Sodium and Ciprofloxacin
REMARKS -
Reference :
49. PRODUCT LEAFLET : Dalacin C, Pfizer Inc.
23.0 CLINDAMYCIN INJECTION
51
Antimicrobial Dilution Protocol (AmDP)
23.2 BRAND : Tidact ®
STRENGTH 300mg in 2ml
RECONSTITUTION/ DILUTION
IM : Inject directly IV infusion : Final diluted concentration must be ≤18mg/ml
i) Dose of 300mg : Reconstitute with 50ml NS. ii) Dose of 600mg : Reconstitute with 100ml NS. iii) Dose of 900mg : Reconstitute with 150ml NS. iv) Dose of 1200mg: Reconstitute with 200ml NS.
ADMINISTRATION
IM : ONLY for dose ≤600mg IV Infusion :
i) Dose of 300mg : over 10 minutes. ii) Dose of 600mg : over 20 minutes. iii) Dose of 900mg : over 30 minutes. iv) Dose of 1200mg: over 45 minutes.
Maximum Rate: <30mg/min
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY -
REMARKS Avoid refrigerate
Reference :
50. PRODUCT LEAFLET : Tidact, Yung Shin Pharmaceutical Ind. Co., Ltd.
23.0 CLINDAMYCIN INJECTION
52
Antimicrobial Dilution Protocol (AmDP)
24.1 BRAND : Cloxacillin Sodium ®
STRENGTH 250mg powder 500mg powder
RECONSTITUTION/ DILUTION
IM : 250mg : Reconstitute with 1.9ml WFI 500mg : Reconstitute with 1.7ml WFI IV Slow bolus : 250mg : Add 4.9ml WFI 500mg : Add 4.8ml WFI IV Infusion : Reconstitute with 5ml WFI Further dilute with 125ml to 250ml of NS Continuous infusion : Reconstitute with 5ml WFI Further dilute with 250ml NS (Dose ≤ 500mg) or 500ml NS (Dose > 500mg) Recommended concentration: 2mg/ml.
ADMINISTRATION
IM Slow IV bolus over 3 - 4 minutes IV infusion: 60 minutes Continuous IV Infusion : 6 -12 hours
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
24 hours - - -
INCOMPATIBILITY Beta lactamase antibacterials, aminoglycosides. They should be administered in separate sites at least 1 hour apart
REMARKS -
Reference :
51. PRODUCT LEAFLET : Cloxacillin Sodium, Karnataka Antibiotics & Pharmaceuticals Ltd.
24.0 CLOXACILLIN INJECTION
53
Antimicrobial Dilution Protocol (AmDP)
25.1 BRAND : Doribax ®
STRENGTH 500mg powder
RECONSTITUTION/ DILUTION
IV : Reconstitute with 10ml WFI / NS
Further dilute with 100ml NS/ D5
ADMINISTRATION IV infusion over 1 hour
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
1 hour - 12 hours (NS) 4 hours (D5)
72 hours (NS) 24 hours (D5)
INCOMPATIBILITY -
REMARKS -
References:
54. PRODUCT LEAFLET : Doribax, Shionogi & Company Ltd. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,
Greenwood Village, Colorado, USA.
25.0 DORIPENEM INJECTION
54
Antimicrobial Dilution Protocol (AmDP)
26.1 BRAND : Invanz ®
STRENGTH 1000mg powder
RECONSTITUTION/ DILUTION
IM : Reconstitute with 3.2ml of 2% Lignocaine HCl Injection IV : Reconstitute with 10ml NS
Further dilute with 50ml NS
ADMINISTRATION IM : Deep IM
IV infusion over 30 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
Information not available (recommend to use
immediately)
6 hours 24 hours
INCOMPATIBILITY Do not use diluents containing dextrose
REMARKS -
Reference :
55. PRODUCT LEAFLET : Invanz, Laboratories Merck Sharp & Dohme-Chibret.
26.0 ERTAPENEM INJECTION
55
Antimicrobial Dilution Protocol (AmDP)
27.1 BRAND : Erythromycin 500mg Injection
STRENGTH 500mg powder
RECONSTITUTION/ DILUTION
IV : Reconstitute with 10 ml WFI Further dilute with 100 - 500 ml of NS/ D5 to a concentration of 1-5 mg/ml
ADMINISTRATION Intermittent infusion over 20 - 60 minutes
STABILITY Information not available (Use immediately after reconstitution)
INCOMPATIBILITY -
REMARKS Bolus injection is not recommended
References :
56. PRODUCT LEAFLET : Erythromycin 500mg Injection Fisiopharma S.r.L. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,
Greenwood Village, Colorado, USA.
27.0 ERYTHROMYCIN INJECTION
56
Antimicrobial Dilution Protocol (AmDP)
28.1 BRAND : Diflucan ®
STRENGTH 100mg in 50ml
RECONSTITUTION/ DILUTION
Ready to use solution
ADMINISTRATION IV infusion over 1 - 2 hour (Maximum rate 200mg/ hour)
STABILITY Single use. Discard any unused portion
INCOMPATIBILITY -
REMARKS -
Reference : 57. PRODUCT LEAFLET : Diflucan, Pfizer.
28.0 FLUCONAZOLE INJECTION
57
Antimicrobial Dilution Protocol (AmDP)
29.1 BRAND : Garasent ®
STRENGTH 80mg in 2ml
RECONSTITUTION/ DILUTION
IM/ IV: Inject directly without further dilution IV infusion : Further dilute with 100 – 200 ml of NS/D5 (Maximum concentration: 1 mg/ ml)
ADMINISTRATION IM Slow IV bolus over 2 - 3 minutes IV infusion over 20 - 30 minutes
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY -
REMARKS -
Reference : 58. PRODUCT LEAFLET : Garasent, Duopharma (M) Sdn Bhd.
29.0 GENTAMICIN INJECTION
58
Antimicrobial Dilution Protocol (AmDP)
30.1 BRAND : Tienem ®
STRENGTH 500mg Imipenem & 500mg Cilastatin powder
RECONSTITUTION/ DILUTION
IV : Reconstitute with 10 ml of NS/ D5 Further dilute to 100 ml of NS/ D5
ADMINISTRATION IV: Dose imipenem ≤ 500 mg: over 20 – 30 minutes Dose imipenem > 500 mg: over 40 – 60 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
4 hours 24 hours Information not available (recommend to use
immediately)
INCOMPATIBILITY -
REMARKS -
Reference : 59. PRODUCT LEAFLET : Tienem Merck Sharp & Dohme.
30.0 IMIPENEM + CILASTATIN INJECTION
59
Antimicrobial Dilution Protocol (AmDP)
31.1 BRAND : Kanamycin Sulphate Injection Meiji
31.2 BRAND : Kanamycin Injection Yung Shin
31.3 BRAND : Kancin-L ®
(Brands above have same information)
STRENGTH 1g in 3ml
RECONSTITUTION/ DILUTION
Inject directly
ADMINISTRATION IM
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY -
REMARKS -
References :
60. PRODUCT LEAFLET : Kanamycin sulfate injection meiji, Thai Meiji Pharmaceutical Co., Ltd.
61. PRODUCT LEAFLET : Kanamycin injection “Yung Shin”, Yung Shin Pharmaceutical Ind. Co., Ltd.
62. PRODUCT LEAFLET : Kancin-L, Altantic Laboratories Corporation Ltd.
31.0 KANAMYCIN INJECTION
60
Antimicrobial Dilution Protocol (AmDP)
32.1 BRAND : Cravit ®
STRENGTH 500mg in 100ml
RECONSTITUTION/ DILUTION
Ready to use solution.
ADMINISTRATION IV Infusion : Slowly over a period of not less than 60 - 90 minutes
STABILITY Samples containing visible particles should be discarded. To be used within 3 hours of opening (rubber stopper perforation)
INCOMPATIBILITY There is no data concerning interaction but quinolones should not be co-administered with any solution containing multivalent cations (e.g. magnesium), through the same line.
REMARKS
Avoid rapid or bolus IV infusion (may lead to hypotension) (Appearance : Sterile, clear, greenish-yellow isotonic solution)
References :
63. PRODUCT LEAFLET : Cravit, Daiichi Sankyo. 100. MIMS Online; http://online1.mimsgateway.com.my.
32.0 LEVOFLOXACIN INJECTION
61
Antimicrobial Dilution Protocol (AmDP)
32.2 BRAND : Levofloxol ®
STRENGTH 500mg in 100ml
RECONSTITUTION/ DILUTION
Ready to use infusion solution
ADMINISTRATION
IV infusion over a period of not less than 60 or 90 minutes, depending on the dosage. The recommended infusion time at least: - 30 minutes for 250 mg - 60 minutes for 500mg
STABILITY Use immediately
INCOMPATIBILITY LEVOFLOXOL should not mixed with heparin or alkaline solutions (eg: sodium hydrogen carbonate)
REMARKS Rapid or bolus IV must be avoided
Reference :
64. PRODUCT LEAFLET : Levofloxol Ain Medicare Sdn. Bhd.
32.0 LEVOFLOXACIN INJECTION
62
Antimicrobial Dilution Protocol (AmDP)
32.3 BRAND : Glevo I.V ®
STRENGTH 500mg in 100ml
RECONSTITUTION/ DILUTION
IV : 250mg dose Dilute with NS/ D5 to final volume 50ml 500mg dose Dilute with NS/ D5 to final volume 100ml 750mg dose Dilute with NS/ D5 to final volume 150ml
ADMINISTRATION
Infuse over at least: - 30 minutes for 250mg - 60 minutes for 500mg - 90 minutes for 750mg
STABILITY
Dilution in NS/ D5:
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
- - 72 hours 14 days
INCOMPATIBILITY Not to be mixed with certain other solutions ( e.g. Sodium Hydrogen Carbonate) or with heparin
REMARKS Rapid or bolus IV must be avoided
References :
65. PRODUCT LEAFLET : Glevo I.V Glenmark Pharma. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics, Greenwood Village, Colorado, USA.
32.0 LEVOFLOXACIN INJECTION
63
Antimicrobial Dilution Protocol (AmDP)
33.1 BRAND : Zyvox ®
STRENGTH 600mg in 300ml
RECONSTITUTION/ DILUTION
Withdraw required dose without further dilution
ADMINISTRATION IV Infusion over 30 - 120 minutes
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY
All drugs below must be avoided in co-administration with Linezolid in Y-site:
- Amphotericin B
- Chlorpromazine HCl
- Diazepam
- Pentamidine Isothionate
- Phenytoin Sodium
- Erythromycin Lactobionate
- Trimethoprim-sulfamethoxazole
REMARKS - Protect from light - Do not use this infusion bag in series connections - Additives should not be introduced into this solution
References :
66. PRODUCT LEAFLET : Zyvox Pfizer Inc. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,
Greenwood Village, Colorado, USA.
33.0 LINEZOLID INJECTION
64
Antimicrobial Dilution Protocol (AmDP)
34.1 BRAND : Meronem ®
STRENGTH 500mg powder 1g powder
RECONSTITUTION/ DILUTION
IV : i) 500mg : Reconstitute with 10ml WFI ii)1 : Reconstitute with 20ml WFI Further dilute with 50 - 500ml NS/D5
ADMINISTRATION Infusion over 15 - 30 minutes
STABILITY
If diluted in D5 : Use it immediately
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
3 hours 12 hours 3 hours (NS) 24 hours (NS)
INCOMPATIBILITY -
REMARKS -
Reference : 67. PRODUCT LEAFLET : Meronem, AstraZeneca.
34.0 MEROPENEM INJECTION
65
Antimicrobial Dilution Protocol (AmDP)
34.2 BRAND : DBL Meropenem ®
STRENGTH 500mg powder 1g powder
RECONSTITUTION/ DILUTION
IV : i) 500mg : Reconstitute with 10ml WFI ii)1g : Reconstitute with 20ml WFI Further dilute with 50 - 200ml NS/ D5
ADMINISTRATION Slow IV bolus over 5 minutes for reconstituted solution Infusion over 15 - 30 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
8 hours (WFI)
24 hours (WFI)
8 hours (NS) 3 hours (D5)
24 hours(NS) 14 hours (D5)
INCOMPATIBILITY -
REMARKS -
Reference :
68. PRODUCT LEAFLET : DBL TM Meropenem Hospira NZ Limited.
34.0 MEROPENEM INJECTION
66
Antimicrobial Dilution Protocol (AmDP)
34.3 BRAND : Monem ®
STRENGTH 500mg powder 1g powder
RECONSTITUTION/ DILUTION
IV : i) 500mg : Reconstitute with 10ml WFI ii)1g : Reconstitute with 20ml WFI Further dilute with 50 - 500ml NS/D5
ADMINISTRATION Slow IV bolus over 3 - 5 minutes for reconstituted solution Infusion over 15 - 30 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
2 hours (WFI)
12 hours (WFI)
2 hours (NS) 1 hours (D5)
18 hours(NS) 8 hours (D5)
INCOMPATIBILITY
Incompatible with drug containing solution of : (avoid the combination of both drugs in Y-site)
- Acyclovir sodium
- Calcium gluconate
- Diazepam
- Doxycycline hyclate
- Ondansetron
REMARKS -
References :
69. PRODUCT LEAFLET : Monem, Biolab. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics, Greenwood Village, Colorado, USA.
34.0 MEROPENEM INJECTION
67
Antimicrobial Dilution Protocol (AmDP)
34.4 BRAND : Meraparon ®
STRENGTH 500mg powder 1g powder
RECONSTITUTION/ DILUTION
IV : i) 500mg : Reconstitute with 10ml WFI ii)1g : Reconstitute with 20ml WFI Further dilute with 50 - 200ml NS/ D5
ADMINISTRATION Slow IV bolus over 5 minutes for reconstituted solution Infusion over 15 - 30 minutes
STABILITY Use immediately
INCOMPATIBILITY -
REMARKS -
Reference :
70. PRODUCT LEAFLET : Meraparon, Novartis Corporation.
34.0 MEROPENEM INJECTION
68
Antimicrobial Dilution Protocol (AmDP)
35.1 BRAND : Metronidazole 500mg Injection 35.2 BRAND : Metronol ® 35.3 BRAND : Metrogyl ® (Brands above have same information)
STRENGTH 500mg in 100ml
RECONSTITUTION/ DILUTION
Infuse directly according the dose needed
ADMINISTRATION Infusion over 20 - 60 minutes
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY -
REMARKS -
References :
71. PRODUCT LEAFLET : Metronidazole, B. Braun Medical Industries Sdn. Bhd. 72. PRODUCT LEAFLET : Metronol Ain Medicare Sdn. Bhd. 73. PRODUCT LEAFLET : Metrogyl, Unique Pharmaceutical Laboratories.
35.0 METRONIDAZOLE INJECTION
69
Antimicrobial Dilution Protocol (AmDP)
36.1 BRAND : Avelox ®
STRENGTH 400mg in 250ml
RECONSTITUTION/ DILUTION
Infuse directly according to the dose needed If necessary , further dilute with the NS/D5
ADMINISTRATION Infusion over 60 minutes
STABILITY Do not refrigerate – product precipitates upon refrigeration Diluted solution stable over 24 hours at room temperature
INCOMPATIBILITY -
REMARKS Only clear solutions are to be used
References :
74. PRODUCT LEAFLET : Avelox, Bayer Schering Pharma AG, Germany. 100. MIMS Online; http://online1.mimsgateway.com.my.
36.0 MOXIFLOXACIN INJECTION
70
Antimicrobial Dilution Protocol (AmDP)
37.1 BRAND : Lotifar ®
STRENGTH 100mg in 2ml 150mg in 2ml
RECONSTITUTION/ DILUTION
IV : Dilute with 50 - 200ml NS /D5
ADMINISTRATION
IM: inject directly Infusion over 1½ to 2 hours (preferable) Slow IV bolus over 3 - 5 minutes
STABILITY
Do not freeze
After Dilution
RT 2 - 8°C
1 week at concentration of 3mg/ml
Information not available (recommend to use
immediately)
INCOMPATIBILITY -
REMARKS
Dark yellow solutions should not be used LOTIFAR 100 MG/2 ML INJECTION is a clear, pale straw coloured solution LOTIFAR 150 MG/2 ML INJECTION is a clear, colourless to pale yellow solution
References :
75. PRODUCT LEAFLET : Lotifar, Duopharma (M) Sdn Bhd. 100. MIMS Online; http://online1.mimsgateway.com.my.
37.0 NETILMYCIN INJECTION
71
Antimicrobial Dilution Protocol (AmDP)
37.2 BRAND : Nelin ®
STRENGTH 100mg in 2ml 150mg in 1.5ml
RECONSTITUTION/ DILUTION
IV : Dilute with 50 - 200ml NS / D5
ADMINISTRATION
IM: inject directly Infusion over 1½ to 2 hours Slow IV bolus over 3 - 5 minutes
STABILITY
After Dilution
RT 2 - 8°C
Use immediately Information not available (recommend to use
immediately)
Use within 3 days after opening
INCOMPATIBILITY -
REMARKS -
References : 76. PRODUCT LEAFLET : Nelin, Biolab Co.,LTD. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,
Greenwood Village, Colorado, USA.
37.0 NETILMYCIN INJECTION
72
Antimicrobial Dilution Protocol (AmDP)
38.1 BRAND : DBL Pentamidine Isethionate Injection ®
STRENGTH 300mg powder
RECONSTITUTION/ DILUTION
IM/IV : Reconstitute with 3 - 5ml WFI/ D5
IV Infusion : Withdraw required dose then further dilute with 50 - 250ml D5/ NS
ADMINISTRATION
IM: Inject directly after reconstitution
Slow IV infusion with a patient in a supine position (to reduce sudden severe hypotension. Infused over 1- 2 hour (the patient is kept lying down)
Direct IV bolus or rapid administration MUST NOT be used
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
48 hours under fluorescent
light
48 hours for concentration
100mg/ml and 60mg/ml
48 hours under fluorescent light for concentration
1.0mg/ml and 2.5mg/ml
-
*To avoid microbial contamination, the prepared solution should be used within 24 hours
INCOMPATIBILITY -
REMARKS Any solution which are hazy, discolored or contain visible particulate matter should not be used
References : 77. PRODUCT LEAFLET : DBL Pentamidine Isethionate Injection Hospira Australia Pty
Ltd. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,
Greenwood Village, Colorado, USA.
38.0 PENTAMIDINE INJECTION
73
Antimicrobial Dilution Protocol (AmDP)
39.1 BRAND : Tazpen ®
STRENGTH 4.5g powder
RECONSTITUTION/ DILUTION
IV : Reconstitute with 20ml WFI/ NS Further dilute with 50ml NS/ WFI/ D5
ADMINISTRATION Slow IV bolus over 3 – 5 minutes Infusion over 20 – 30 minutes
STABILITY
Vials should not be frozen after reconstitution
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
24 hours 48 hours Information not available (recommend to use immediately)
INCOMPATIBILITY Aminoglycosides, Heparin, Vecuronium, Methotrexate
REMARKS -
Reference : 78. PRODUCT LEAFLET : Tazpen, Strides Arcolab Ltd.
39.0 PIPERACILLIN + TAZOBACTAM INJECTION
74
Antimicrobial Dilution Protocol (AmDP)
39.2 BRAND : DBL Piperacillin And Tazobactam For Injection ®
STRENGTH 4.5g powder
RECONSTITUTION/ DILUTION
IV : Reconstitute with 10ml WFI/ NS for 2.25g vial Reconstitute with 20ml WFI/ NS for 4.5g vial
Further dilute with 50ml NS or D5
ADMINISTRATION Slow infusion over 20 - 30 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
-
24 hours Use immediately
INCOMPATIBILITY Lactated ringer solution, solution containing only Sodium Bicarbonate or having pH basic range
REMARKS -
Reference : 79. PRODUCT LEAFLET : DBL Piperacillin And Tazobactam For Injection Hospira NZ
Limited.
39.0 PIPERACILLIN + TAZOBACTAM INJECTION
75
Antimicrobial Dilution Protocol (AmDP)
39.3 BRAND : Tapicin ®
STRENGTH 4.5g powder
BRAND NAME Tapicin®
RECONSTITUTION/ DILUTION
IV : Reconstitute with 10ml WFI/ NS for 2.25g vial Reconstitute with 20ml WFI/ NS for 4.5g vial
Further dilute with 50ml - 150ml NS/ D5
ADMINISTRATION Slow IV bolus over 3 - 5 minutes IV infusion over 20 - 30 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
24 hours 7days Use immediately
INCOMPATIBILITY Aminoglycoside, high dose Heparin, oral anticoagulants, Vecuronium, Methotrexate, solution containing Sodium Bicarbonate
REMARKS -
Reference : 80. PRODUCT LEAFLET : Tapicin, Yung Shin Pharmaceutical (M) Sdn Bhd.
39.0 PIPERACILLIN + TAZOBACTAM INJECTION
76
Antimicrobial Dilution Protocol (AmDP)
39.4 BRAND : Tazocin EF ®
STRENGTH 4.5g powder
BRAND NAME Tazocin EF Injection 4.5g
RECONSTITUTION/ DILUTION
IV : Reconstitute with 20ml WFI/ NS/ D5 for 4.5g vial
Further dilute with 50ml to 150ml NS/ WFI/ D5 *Maximum recommended volume of WFI per dose is 50ml
ADMINISTRATION Slow IV bolus over 3 - 5 minutes IV infusion over 20 - 30 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
24 hours 48 hours Use Immediately
Not to be frozen
INCOMPATIBILITY Aminoglycoside, solutions containing Sodium Bicarbonate alone or solutions that significantly alter the pH, blood products or Albumin hydrolysates
REMARKS -
Reference : 81. PRODUCT LEAFLET : Tazocin EF Pfizer Limited.
39.0 PIPERACILLIN + TAZOBACTAM INJECTION
77
Antimicrobial Dilution Protocol (AmDP)
40.1 BRAND : Poly-B ®
STRENGTH 500,000 units powder
RECONSTITUTION/ DILUTION
IM : Reconstitute with 2ml WFI /NS
IV : Reconstitute with 5ml of D5 Further dilute with 300 – 500ml of D5 Intrathecal: Reconstitute with 10ml NS
ADMINISTRATION
IM (not recommended routinely because of severe pain at injection sites particularly in infants and children)
IV: infusion durations of 60 - 120 minutes Intrathecal (treatment of choice for Ps. Aeruginosa meningitis) : Administer 50, 000 units (1ml) intrathecally
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
- 72 hours Information not available (recommend to use immediately)
INCOMPATIBILITY -
REMARKS Protect from light
References:
82. PRODUCT LEAFLET : Polymyxin B for injection USP, XGen Pharmaceuticals Inc. 83. PRODUCT LEAFLET : Poly-B, Samarth Life Sciences Pt Ltd. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,
Greenwood Village, Colorado, USA.
40.0 POLYMYXIN B INJECTION
78
Antimicrobial Dilution Protocol (AmDP)
41.1 BRAND : Streptin ®
STRENGTH 1g powder
RECONSTITUTION/ DILUTION
IM : Reconstitute with 3.2 - 3.5ml of WFI/NS (final concentration : 250mg/ml)
ADMINISTRATION IM only
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
- 24 hours Information not available (recommend to use immediately)
INCOMPATIBILITY -
REMARKS Protect from light and freezing. Exposure to light causes darkening of solution without apparent loss of potency
References :
84. PRODUCT LEAFLET : Streptin, SM Pharmaceuticals Sdn Bhd. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,
Greenwood Village, Colorado, USA.
41.0 STREPTOMYCIN INJECTION
79
Antimicrobial Dilution Protocol (AmDP)
41.2 BRAND : Meiji ®
STRENGTH 1g powder
RECONSTITUTION/ DILUTION
IM : Reconstitute with 3.2ml of WFI/NS (final concentration : 250mg/ml)
Inhalation : Reconstitute with 5ml of NS Further dilute with 25 - 50ml NS
ADMINISTRATION
IM
Inhalation: Nebulize and inhale 1 -15ml of solution every 4 to 6hrs
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY -
REMARKS Protect from light Concomitant IM may be required in many cases for inhaled streptomycin
References :
85. PRODUCT LEAFLET : Meiji, PT Meiji Indonesian Pharmaceutical Industries. 102. Medscape : Streptomycin. Incompatibility;
http://reference.medscape.com/drug/streptomycin-342682#11.
41.0 STREPTOMYCIN INJECTION
80
Antimicrobial Dilution Protocol (AmDP)
41.3 BRAND : Sterile Streptomycin Sulfate For Injection
STRENGTH 1g powder
RECONSTITUTION/ DILUTION
IM : Reconstitute with 3.2ml of WFI (final concentration : 250mg/ml)
ADMINISTRATION IM only
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY
-
REMARKS Protect from light
Reference :
86. PRODUCT LEAFLET : Sterile Streptomycin Sulfate for Injection, Karnataka Antibiotics & Pharmaceuticals Limited.
41.0 STREPTOMYCIN INJECTION
81
Antimicrobial Dilution Protocol (AmDP)
42.1 BRAND : DBL Sulfamethoxazole 400mg & Trimethoprim 80mg
STRENGTH Sulfamethoxazole 400mg/ Trimethoprim 80mg
RECONSTITUTION/ DILUTION
IV : Dilute : 1 ampoule to 125ml NS/ D5 2 ampoule to 250ml NS/ D5 3 ampoule to 500ml NS/ D5 In fluid restriction, dilute 1 ampoule to 75ml D5
ADMINISTRATION IV infusion should not exceed 1½ hours
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
Information not available (recommend to use immediately)
24 hours NA
INCOMPATIBILITY -
REMARKS Do not administer IM
References :
87. PRODUCT LEAFLET : DBL Sulfamethoxazole 400mg & Trimethoprim 80mg Hameln pharmaceuticals GmbH.
99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics, Greenwood Village, Colorado, USA.
42.0 SULFAMETHOXAZOLE + TRIMETHOPRIM INJECTION
82
Antimicrobial Dilution Protocol (AmDP)
43.1 BRAND : Vancomycin Hydrochloride for Injection
STRENGTH 500mg powder
RECONSTITUTION/ DILUTION
IV : 500mg : Reconstitute with 10ml of WFI Further dilute with at least 100 ml of NS/ D5 1g : Reconstitute with 20ml of WFI Further dilute with at least 200 ml of NS/ D5 (Maximum concentration: 5mg/ml)
ADMINISTRATION
≤1g : Infusion over a period of at least 60 minutes, or at maximum infusion rates of 10mg/min, whichever is longer
>1g: Infusion at rate 10mg/min
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
2 days 14 days - 14 days (D5 or NS)
INCOMPATIBILITY -
REMARKS Concentrations of not more than 5mg/ml and rates of not more than 10mg/min are recommended to prevent infusion related reaction ( Red Man Syndrome)
References :
88. PRODUCT LEAFLET : Vancomycin Hydrochloride for Injection, USP, Hospira Inc. 103. http://www.globalrph.com/vancomycin_dilution.htm.
43.0 VANCOMYCIN INJECTION
83
Antimicrobial Dilution Protocol (AmDP)
43.2 BRAND : Vancotex Injection 500mg
STRENGTH 500mg powder
RECONSTITUTION/ DILUTION
IV : For 500mg : Reconstitute with 10ml of WFI Further dilute with at least 100 ml of NS/D5
ADMINISTRATION
≤1g : Infusion over a period of at least 60 minutes, or at maximum infusion rates of 10mg/min, whichever is longer
>1g: Infusion at rate 10mg/min
STABILITY Freshly prepared and discard the unused portion
INCOMPATIBILITY -
REMARKS Maximum concentration allowed is 10mg/ml for fluid restriction but increased the risk of infusion-related effects ( Red Man Syndrome)
Reference :
89. PRODUCT LEAFLET : Vancotex Injection Fisiopharma S.r.L, Nucleo Industriale.
43.0 VANCOMYCIN INJECTION
84
Antimicrobial Dilution Protocol (AmDP)
44.1 BRAND : Vfend ®
STRENGTH 200mg powder
RECONSTITUTION/ DILUTION
IV : Reconstitute with 19ml WFI (final concentration: 10mg/ml) Withdraw the required amount of 10mg/ml VFEND concentrate (Refer Table 1) Then, further dilute the concentrate with NS/ D5 up to:- i) 50ml : Dose of 25 - 250mg ii) 100ml : Dose of 251 - 500mg iii) 150ml : Dose of 501 - 600mg (final concentration should be within 0.5 - 5mg/ml)
ADMINISTRATION Infusion over 1 - 2 hours At a maximum rate of 3mg/kg/hour
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
- 24 hours Information not available (recommend to use immediately)
INCOMPATIBILITY Blood products and concentrated electrolytes MUST NOT be infused concomitantly with Voriconazole even in separate infusion lines
REMARKS Not recommended for bolus injection Refer to table 1 for required volumes of 10mg/ml VFEND Concentrate table
Reference ;
90. PRODUCT LEAFLET : Vfend, Pfizer Inc.
44.0 VORICONAZOLE INJECTION
85
Antimicrobial Dilution Protocol (AmDP)
Table 1
Required Volumes of 10 mg/ml VFEND Concentrate
Body Weight
(kg)
Volume of VFEND Concentrate (10mg/ml) required for:
3 mg/kg dose (number of
vials)
4 mg/kg dose (number of
vials)
6 mg/kg dose (number of
vials)
8 mg/kg dose (number of
vials)
9 mg/kg dose (number of
vials)
10 - 4.0ml (1) - 8.0 ml (1) 9.0 ml (1)
15 - 6.0ml (1) - 12.0 ml (1) 13.5 ml (1)
20 - 8.0ml (1) - 16.0 ml (1) 18.0 ml (1)
25 - 10.0ml (1) - 20.0 ml (1) 22.5 ml (2)
30 9.0ml (1) 12.0ml (1) 18.0ml (1) 24.0 ml (2) 27.0 ml (2)
35 10.5ml (1) 14.0ml (1) 21.0ml (2) 28.0 ml (2) 31.5 ml (2)
40 12.0ml (1) 16.0ml (1) 24.0ml (2) 32.0 ml (2) 36.0 ml (2)
45 13.5ml (1) 18.0ml (1) 27.0ml (2) 36.0 ml (2) 40.5 ml (3)
50 15.0ml (1) 20.0ml (1) 30.0ml (2) 40.0 ml (2) 45.0 ml (3)
55 16.5ml (1) 22.0ml (2) 33.0ml (2) 44.0 ml (3) 49.5 ml (3)
60 18.0ml (1) 24.0ml (2) 36.0ml (2) 48.0 ml (3) 54.0 ml (3)
65 19.5ml (1) 26.0ml (2) 39.0ml (2) 52.0 ml (3) 58.5 ml (3)
70 21.0ml (2) 28.0ml (2) 42.0ml (3) - -
75 22.5ml (2) 30.0ml (2) 45.0ml (3) - -
80 24.0ml (2) 32.0ml (2) 48.0ml (3) - -
85 25.5ml (2) 34.0ml (2) 51.0ml (3) - -
90 27.0 ml (2) 36.0 ml (2) 54.0 ml (3) - -
95 28.5 ml (2) 38.0 ml (2) 57.0 ml (3) - -
100 30.0 ml (2) 40.0 ml (2) 60.0 ml (3) - -
86
Antimicrobial Dilution Protocol (AmDP)
45.1 BRAND : Retro ®
STRENGTH 200ml in 20ml
RECONSTITUTION/ DILUTION
MUST be diluted prior to administration IV : Withdraw the required dose from the vial Then, further dilute with D5 up to :- i) 50ml : Dose of ≤200mg ii) 100ml : Dose of 201 – 400mg (final concentration should NOT exceed 4mg/ml)
ADMINISTRATION
Intermittent infusion: Infused over 1 hour
Continuous infusion (Prevention of maternal - fetal HIV transmission): 2mg/kg infused over 1 hour, followed by 1mg/kg/hr until umbilical cord is clamped
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
Information not available (recommend to use immediately)
48 hours
INCOMPATIBILITY -
REMARKS Protect from light
References :
91. PRODUCT LEAFLET : Retro, Glaxo Wellcome Operations, ViiV Healthcare. 107. http://www.globalrph.com/zidovudine_dilution.htm.
45.0 ZIDOVUDINE INJECTION
87
Antimicrobial Dilution Protocol (AmDP)
1. Daptomycin Injection
BRAND : Cubicin ®
STRENGTH 500 mg lyophilized powder
RECONSTITUTION/ DILUTION
IV : Reconstitute with 10ml NS Further dilute with 50ml NS
ADMINISTRATION IV : i) IV slow bolus, Inject over 2 minutes after reconstitution ii) Infuse over 30 minutes
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
12 hours 48 hours 12 hours 48 hours
INCOMPATIBILITY Dextrose containing diluents
REMARKS AVOID vigorous shaking of the vial during or after reconstitution
References : 92. PRODUCT LEAFLET : Cubicin, Cubist Pharmaceuticals, Inc. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,
Greenwood Village, Colorado, USA. 108. http://www.globalrph.com/daptomycin_dilution.htm.
NON-FORMULARY INJECTION
88
Antimicrobial Dilution Protocol (AmDP)
2. Liposomal Amphotericin B Injection
BRAND : Ampholip ®
STRENGTH 50mg in 10ml
RECONSTITUTION/ DILUTION
IV : Further dilute with 40ml of D5 (1mg/ml)
ADMINISTRATION IV : Infuse at a rate of 2.5 mg/kg/hr
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY NS
REMARKS
Protect from light
Do not use an on-line microbial filter
Desired dose should withdraw using an 18G needle
Further dilution should done using 5μ filter needle
supplied with each vial pack
Mix the contents of the bag by shaking the infusion
bag every two hours
An existing IV line should flushed with D5 before
infusion of Ampholip
An initial test dose of 1.0 mg should be infused
intravenously over 15 minutes
Reference : 93. PRODUCT LEAFLET : Ampholip Bharat Serums And Vaccines Limited
NON-FORMULARY INJECTION
89
Antimicrobial Dilution Protocol (AmDP)
3. Micafungin Sodium Injection
BRAND : Mycamine ®
STRENGTH 50mg powder
RECONSTITUTION/ DILUTION
IV : Reconstitute with 5ml of NS/ D5 Further dilute with 100ml with NS/ D5
ADMINISTRATION IV: Infuse over 1 hour
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
24 hours NA 24 hours NA
INCOMPATIBILITY -
REMARKS
Protect from light More rapid infusions may result in more frequent histamine mediated reaction
Reference : 94. PRODUCT LEAFLET : Mycamine, Cubist Pharmaceuticals, Inc.
NON-FORMULARY INJECTION
90
Antimicrobial Dilution Protocol (AmDP)
4. Colistimethate Sodium (Polymyxcin E) Injection
BRAND : Colomycin ®
STRENGTH One million units powder
RECONSTITUTION/ DILUTION
IV : Reconstitute with 10ml of NS Further dilute with 50ml NS Nebusation solution : 1 million unit – add 2ml NS 2 million unit – add 4ml NS
ADMINISTRATION
IV : Infuse over 30 minutes
If Totally Implantable Venous Access Device (TIVAD) in place, bolus injection of up to 2 million units in 10ml given over a minimum of 5 minutes
STABILITY
Preparation After Reconstitution
After Dilution
RT 2 - 8°C RT 2 - 8°C
Intravenous NA 24 hours NA 24 hours
Nebulisation solution
NA 24 hours NA NA
INCOMPATIBILITY -
REMARKS -
References : 95. PRODUCT LEAFLET : Colomycin, Xellia Pharmaceuticals APS. 104. https://www.medicines.org.uk/emc/medicine/1590.
NON-FORMULARY INJECTION
91
Antimicrobial Dilution Protocol (AmDP)
5.1 Tigecyclin Injection
BRAND : Tygacil ®
STRENGTH 50 mg lyophilized powder
RECONSTITUTION/ DILUTION
IV : Reconstitute with 5.3mL* of NS/ D5 Withdraw 5ml from reconstituted solution & further dilute with 100ml with NS/ D5
Maximum concentration per bag 1mg/ml
ADMINISTRATION IV : Infusion over 30 minutes to 1 hour
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
24 hours
NA 24 hours 48 hours
INCOMPATIBILITY -
REMARKS -
* Each vial contains a 6% overage. Thus, 5ml of reconstituted solution is equivalent to
50mg of the drug
References : 96. PRODUCT LEAFLET : Tygacil, Wyeth Pharmaceuticals Inc. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,
Greenwood Village, Colorado, USA.
NON-FORMULARY INJECTION
92
Antimicrobial Dilution Protocol (AmDP)
6.0 Pentamidine Isethionate BP Injection
BRAND : Pentacarinat ®
STRENGTH 300mg powder
RECONSTITUTION/ DILUTION
Nebulisation solution : Add 4 - 6mL of WFI IM : Reconstitute with 3ml WFI IV infusion : Reconstitute with 3 - 5ml WFI Further dilute with 50ml - 250ml with NS /D5
ADMINISTRATION IV infusion : Infuse over 1 hour
STABILITY
After Reconstitution After Dilution
RT 2 - 8°C RT 2 - 8°C
Information not available (recommend to use immediately)
NA 24 hours
INCOMPATIBILITY -
REMARKS
Sudden, severe hypotension may occur after a single dose of Pentamidine Isethionate has been given parenterally: - Baseline blood pressure should be established - Patients should receive the drug during lying down - Blood pressure should be closely monitored
* Reserved for nebulization only.
If IV needed , use brand DBL Pentamidine (refer to 4.38 Pentamidine Inj; page 72)
References : 97. PRODUCT LEAFLET : Pentacarinat Sanofi-aventis New Zealand Limited. 109. Martidale : The Complete Drug Reference. 33th ed.
NON-FORMULARY INJECTION
93
Antimicrobial Dilution Protocol (AmDP)
7. Quinine Dihydrochloride Injection
BRAND : Malakin Injection 2mL ®
STRENGTH 600ml in 2ml
RECONSTITUTION/ DILUTION
IV : Dilute with 250ml - 500ml NS
ADMINISTRATION
IV :
i. 7 mg dihydrochloride salt/kg infused over 30 minutes
Followed by 10mg salt/kg over a period of 4 hours
ii. For severe malaria : 20 mg of the dihydrochloride salt (16.7
mg base)/kg infused over 4 hours
Followed by 10mg salt/kg infused over 2 - 8 hours
STABILITY Information not available (recommend to use immediately)
INCOMPATIBILITY -
REMARKS -
References : 98. PRODUCT LEAFLET : Malakin Injection Duopharma (M) Sdn Bhd. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,
Greenwood Village, Colorado, USA.
NON-FORMULARY INJECTION
94
Antimicrobial Dilution Protocol (AmDP)
BW : Body weight
D5 : Dextrose 5%
GA : General Anaesthesia
IM : Intramuscular
IV : Intravenous
LR : Lactate Ringer
N/A : Not Applicable
NS : Sodium Chloride 0.9%
RF : Refrigerator (2 - 8 C)
RT : Room Temperature (15 - 30 C)
SC : Subcutaneous
WFI : Water For Injection
Wt : Weight
ABBREVIATION
95
Antimicrobial Dilution Protocol (AmDP)
REFERENCES:
1. PRODUCT LEAFLET : Zovirax For Infusion 250mg, GlaxoSmithKline. 2. PRODUCT LEAFLET : Medovir 250mg Injectible, Medochemie. 3. PRODUCT LEAFLET : DBL Acyclovir Hospira. 4. PRODUCT LEAFLET: Vaxcel Acyclovir Kontra Pharma. 5. PRODUCT LEAFLET : Eraxis, Pfizer. 6. PRODUCT LEAFLET : Apalin, CCM Duopharma Bio Tech. 7. PRODUCT LEAFLET : Selemycin Medochemie Ltd, Cyprus. 8. PRODUCT LEAFLET : Augmentin Intravenous GlaxoSmithKline 9. PRODUCT LEAFLET : Clamentin Injection, Yung Shin Pharmaceutical Ind. Co., Ltd. 10. PRODUCT LEAFLET : Co-Amoxiclav Injection Averroes Pharmaceuticals Sdn Bhd. 11. PRODUCT LEAFLET : Ampicillin Sodium for Injection B, Karnataka Antibiotics &
Pharmaceuticals Limited, India; July 2009. 12. PRODUCT LEAFLET : Pamecil, Medochemie Ltd, Selangor. 13. PRODUCT LEAFLET : Standacillin, Sandoz. 14. PRODUCT LEAFLET : Ampicillin & Sulbactam powder for injection Karnataka
Antibiotics & Pharmaceuticals Limited, India; August 2010. 15. PRODUCT LEAFLET : Sulbacin, Unichem. 16. PRODUCT LEAFLET : Amphotret Bharat Serums And Vaccines Ltd. 17. PRODUCT LEAFLET : Artesun, Guilin Pharmaceutical Co Ltd. 18. PRODUCT LEAFLET : Azee, Cipla United. 19. PRODUCT LEAFLET : Zitromax, Pfizer. 20. PRODUCT LEAFLET : Retarpen, Sandoz. 21. PRODUCT LEAFLET : Sterile Penicillin G benzathine 2.4 mega units, Karnataka
Antibiotics & Pharmaceuticals Limited, India; August 2010. 22. PRODUCT LEAFLET : Cancidas, Merck Sharp & Dohme. 23. PRODUCT LEAFLET : Cefazolin Sandoz. 24. PRODUCT LEAFLET : Reflin, Ranbaxy. 25. PRODUCT LEAFLET : Verapime, Demo S.A Pharmaceutical Industry. 26. PRODUCT LEAFLET : Vaxcel Cefepime Kotra Pharma (M) Sdn. Bhd. 27. PRODUCT LEAFLET : Forpar, Cipla (M) Sdn. Bhd. 2014. 28. PRODUCT LEAFLET : Megapime, Alkem Lab Ltd. 2006. 29. PRODUCT LEAFLET : Sefepim, Hovid Sdn Bhd. 2014. 30. PRODUCT LEAFLET : Rekaxime, Duopharma (M) Sdn Bhd. 2011. 31. PRODUCT LEAFLET : Claraxim, Siam Bheasach Co. Ltd. 2006. 32. PRODUCT LEAFLET : Claforan, Aventis Pharma. 33. PRODUCT LEAFLET : Vaxcel Cefotaxime, Kotra Pharma (M) Sdn.Bhd. . 34. PRODUCT LEAFLET : Bicafar, Duopharma (M) Sdn Bhd. 2012. 35. PRODUCT LEAFLET : Vaxcel Cefoperazone, Kotra Pharma (M) Sdn.Bhd. . 36. PRODUCT LEAFLET : Vaxcel Cefobactam, Kotra Pharma (M) Sdn.Bhd. . 37. PRODUCT LEAFLET : Cefper Biolab Co. LTD, 2009. 38. PRODUCT LEAFLET : Cefoperazone & Sulbactam 1.0G, Karnataka Antibiotics &
Pharmaceuticals Limited, 2010. 39. PRODUCT LEAFLET : Zinforo, Facta Farmaceutici S.p.A, October 2012. 40. PRODUCT LEAFLET : Cefatum, Duopharma (M) Sdn Bhd, 6 August 2010. 41. PRODUCT LEAFLET : Fortum, GlaxoSmithKline. 42. PRODUCT LEAFLET : Unocef, Duopharma (M) Sdn Bhd, 27 July 2010. 43. PRODUCT LEAFLET : Rocephin, Roche. 44. PRODUCT LEAFLET : Zinacef, GlaxoSmithKline.
REFERENCES
96
Antimicrobial Dilution Protocol (AmDP)
45. PRODUCT LEAFLET : Anikef Duopharma (M) Sdn Bhd, 2 September 2013. 46. PRODUCT LEAFLET : Ciproxol Ain Medicare Sdn. Bhd. 47. PRODUCT LEAFLET : Ciprobay, Bayer Co. (Malaysia) Sdn Bhd. 48. PRODUCT LEAFLET : Ufexil DEMO S.A. 49. PRODUCT LEAFLET : Dalacin C, Pfizer Inc. 50. PRODUCT LEAFLET : Tidact, Yung Shin Pharmaceutical Ind. Co., Ltd. 51. PRODUCT LEAFLET :Cloxacillin Sodium, Karnataka Antibiotics & Pharmaceuticals
Ltd. 52. PRODUCT LEAFLET : Penicilin G Sodium Sandoz, Sandoz GmbH 53. PRODUCT LEAFLET : Benzyl Penicillin For Injection, Karnataka Antibiotics &
Pharmaceuticals Ltd. 54. PRODUCT LEAFLET : Doribax, Shionogi & Company Ltd. 55. PRODUCT LEAFLET : Invanz, Laboratories Merck Sharp & Dohme-Chibret. 56. PRODUCT LEAFLET : Erythromycin 500mg Injection Fisiopharma S.r.L. 57. PRODUCT LEAFLET : Diflucan, Pfizer. 58. PRODUCT LEAFLET : Garasent, Duopharma (M) Sdn Bhd. 59. PRODUCT LEAFLET : Tienem Merck Sharp & Dohme. 60. PRODUCT LEAFLET : Kanamycin sulfate injection meiji, Thai Meiji Pharmaceutical
Co., Ltd. 61. PRODUCT LEAFLET : Kanamycin injection “Yung Shin”, Yung Shin Pharmaceutical
Ind. Co., Ltd. 62. PRODUCT LEAFLET : Kancin-L, Altantic Laboratories Corporation Ltd. 63. PRODUCT LEAFLET : Cravit, Daiichi Sankyo. 64. PRODUCT LEAFLET : Levofloxol Ain Medicare Sdn. Bhd. 65. PRODUCT LEAFLET : Glevo I.V Glenmark Pharma. 66. PRODUCT LEAFLET : Zyvox Pfizer Inc. 67. PRODUCT LEAFLET : Meronem, AstraZeneca. 68. PRODUCT LEAFLET : DBL TM Meropenem Hospira NZ Limited. 69. PRODUCT LEAFLET : Monem, Biolab. 70. PRODUCT LEAFLET : Meraparon, Novartis Corporation. 71. PRODUCT LEAFLET : Metronidazole, B. Braun Medical Industries Sdn. Bhd. 72. PRODUCT LEAFLET : Metronol Ain Medicare Sdn. Bhd. 73. PRODUCT LEAFLET : Metrogyl, Unique Pharmaceutical Laboratories. 74. PRODUCT LEAFLET : Avelox, Bayer Schering Pharma AG, Germany. 75. PRODUCT LEAFLET : Lotifar, Duopharma (M) Sdn Bhd. 76. PRODUCT LEAFLET : Nelin, Biolab Co.,LTD. 77. PRODUCT LEAFLET : DBL Pentamidine Isethionate Injection Hospira Australia Pty
Ltd. 78. PRODUCT LEAFLET : Tazpen, Strides Arcolab Ltd. 79. PRODUCT LEAFLET : DBL Piperacillin And Tazobactam For Injection Hospira NZ
Limited. 80. PRODUCT LEAFLET : Tapicin, Yung Shin Pharmaceutical (M) Sdn Bhd. 81. PRODUCT LEAFLET : Tazocin EF Pfizer Limited. 82. PRODUCT LEAFLET : Polymyxin B for injection USP, XGen Pharmaceuticals Inc. 83. PRODUCT LEAFLET : Poly-B, Samarth Life Sciences Pt Ltd. 84. PRODUCT LEAFLET : Streptin, SM Pharmaceuticals Sdn Bhd. 85. PRODUCT LEAFLET : Meiji, PT Meiji Indonesian Pharmaceutical Industries. 86. PRODUCT LEAFLET : Sterile Streptomycin Sulfate for Injection, Karnataka
Antibiotics & Pharmaceuticals Limited. 87. PRODUCT LEAFLET : DBL Sulfamethoxazole 400mg & Trimethoprim 80mg
Hameln pharmaceuticals GmbH. 88. PRODUCT LEAFLET : Vancomycin Hydrochloride for Injection, USP, Hospira Inc. 89. PRODUCT LEAFLET : Vancotex Injection Fisiopharma S.r.L, Nucleo Industriale. 90. PRODUCT LEAFLET : Vfend, Pfizer Inc. 91. PRODUCT LEAFLET : Retro, Glaxo Wellcome Operations, ViiV Healthcare.
97
Antimicrobial Dilution Protocol (AmDP)
92. PRODUCT LEAFLET : Cubicin, Cubist Pharmaceuticals, Inc. 93. PRODUCT LEAFLET : Ampholip Bharat Serums And Vaccines Limited 94. PRODUCT LEAFLET : Mycamine, Cubist Pharmaceuticals, Inc. 95. PRODUCT LEAFLET : Colomycin, Xellia Pharmaceuticals APS. 96. PRODUCT LEAFLET : Tygacil, Wyeth Pharmaceuticals Inc. 97. PRODUCT LEAFLET : Pentacarinat Sanofi-aventis New Zealand Limited. 98. PRODUCT LEAFLET : Malakin Injection Duopharma (M) Sdn Bhd. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,
Greenwood Village, Colorado, USA. 100. MIMS Online; http://online1.mimsgateway.com.my. 101. Drug Information Handbook. 23rd ed. Vol. 2014-2015: Hudson, Ohio, Lexi-Comp, Inc. 102. Medscape : Streptomycin. Incompatibility;
http://reference.medscape.com/drug/streptomycin-342682#11. 103. http://www.globalrph.com/vancomycin_dilution.htm. 104. https://www.medicines.org.uk/emc/medicine/1590. 105. Injectable Drugs Dilution 2010, Bahagian Perkhidmatan Farmasi Perak. 106. Guidelines on Reconstitution & Administration of Injectable Drugs. 2013, Hospital
Kuala Lipis. 107. http://www.globalrph.com/zidovudine_dilution.htm. 108. http://www.globalrph.com/daptomycin_dilution.htm. 109. Martidale : The Complete Drug Reference. 33th ed. 110. Medication Errors and Syringe Safety Are Top Concerns for Nurses According to
New National Study [press release].http://www.nursingworld.org/Functional Menu Categories/ Media Resources /Press Releases/2007
111. Intravenous Drugs Preparation & Administration Quick Reference, Medical Department & Pharmacy Department Kuala Lumpur Hospital, 2011 112. John D & Rebecca L, 2010. Guide to the Safe Preparation and Administration of Intravenous (IV) Antibiotics at Home. http://www.newcastle- hospitals.org.uk/downloads/cardiothoracic/Patient_info_- _safe_prep_and_admin_of_IV_ab.pdf 113. Dilution Protocol 2010, Hospital Selayang 2nd Edition