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Fernández-Rubio B, Herrera-Hidalgo L, López-Cortés LE, Luque-Márquez R, De Alarcón A, Luque-Pardos S, Fernández-Polo A, Gutiérrez-Urbón JM, Rodríguez-Baño J, Gil-Navarro MV, Gutiérrez-Valencia A. Stability of temocillin in outpatient parenteral antimicrobial therapy: is it a real option? J Antimicrob Chemother 2023; 78:2451-2456. [PMID: 37574704 DOI: 10.1093/jac/dkad251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Temocillin is an interesting alternative to carbapenems for susceptible Enterobacteriaceae. Although its use in outpatient parenteral antimicrobial therapy (OPAT) programmes has generated interest, this has been hampered by the lack of stability data. OBJECTIVES The purpose of the present study was to evaluate the physical and chemical stability of temocillin at the recommended dose for its use in OPAT programmes, contained in polypropylene infusion bags or polyisoprene elastomeric devices at different temperatures, and to describe a novel LC-MS/MS developed for the quantification of temocillin. METHODS Temocillin daily dose (6 g) was diluted in 500 mL of 0.9% sodium chloride to obtain a final concentration of 12 g/L. This solution was stored at 4°C, 25°C, 32°C and 37°C for 72 h, both in polypropylene infusion bags and in polyisoprene elastomeric pumps. Physical and chemical stability were evaluated during 72 h after manufacturing. Solutions were considered stable if colour, clearness and pH remained unchanged and if the percentage of intact drug was ≥90%. RESULTS Temocillin attained the chemical stability criterion of ≥90% of the original concentration for the whole experiment in both devices at 4°C, 25°C and 32°C. At 37°C, temocillin was stable for 24 h but its concentration dropped below 90% from that timepoint. No precipitation occurred and minor colour changes were observed. CONCLUSIONS Temocillin is stable under OPAT conditions and it would be an appropriate candidate for the treatment of patients who can be discharged to complete therapy in an OPAT programme. For this study, an LC-MS/MS method was developed.
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Affiliation(s)
- Beatriz Fernández-Rubio
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Laura Herrera-Hidalgo
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
- Unidad de Gestión Clinica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Luis E López-Cortés
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
- Departament of Medicine, School of Medicine, University of Sevilla, Seville, Spain
| | - Rafael Luque-Márquez
- Unidad de Gestión Clinica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Arístides De Alarcón
- Unidad de Gestión Clinica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Sonia Luque-Pardos
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Unidad de Gestión Clínica de Farmacia, Hospital del Mar, Barcelona, Spain
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Aurora Fernández-Polo
- Unidad de Gestión Clínica de Farmacia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Jesús Rodríguez-Baño
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
- Departament of Medicine, School of Medicine, University of Sevilla, Seville, Spain
| | - María Victoria Gil-Navarro
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
- Unidad de Gestión Clinica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Alicia Gutiérrez-Valencia
- Unidad de Gestión Clinica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
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Sime FB, Wallis S, Jamieson C, Hills T, Gilchrist M, Santillo M, Seaton RA, Drummond F, Roberts J. Evaluation of the stability of temocillin in elastomeric infusion devices used for outpatient parenteral antimicrobial therapy in accordance with the requirements of the UK NHS Yellow Cover Document. Eur J Hosp Pharm 2023; 30:e76-e81. [PMID: 35609967 PMCID: PMC10086727 DOI: 10.1136/ejhpharm-2022-003286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/03/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the stability of temocillin solution in two elastomeric infusion devices - Easypump II LT 270-27- S and Dosi-Fusor L25915-250D1 for OPAT administration during 14 days of 5°C±3°C fridge storage followed by 24 hour exposure at an in-use temperature of 32°C, when reconstituted with 0.3% citrate buffer at pH7. METHODS Stability testing was conducted in accordance with standard protocols in the UK National Health Service Yellow Cover Document (YCD). A stability indicating assay method was applied using a high-performance liquid chromatography (HPLC) system with a photodiode array detector. Low (500 mg/240 mL), intermediate (4000 mg/240 mL) and high (6000 mg/240 mL) temocillin concentrations were tested in triplicate devices with duplicate samples taken at 11 time points during fridge storage and subsequent in-use temperature exposure. RESULT The percentage of temocillin remaining after 14 days of fridge storage was greater than 97% in both devices and at all concentrations tested. During subsequent in-use temperature exposure, a 95% stability limit was achieved for 12 hours except for the high concentration (25 mg/mL) in the Dosi-Fusor device. It met this criterion for only 10 hours - the percent of temocillin remaining at 12 hours was 94.5%. However, for all devices and the doses tested, the degradation of temocillin was <9% at the end of 24 hours in-use temperature exposure. CONCLUSION Temocillin reconstituted with 0.3% citrate buffer at pH7 in elastomeric infusion devices can be stored in a fridge (2°C-8°C) for 14 days meeting the YCD acceptance criteria. Considering <5% degradation, the current data supports twice daily dosing of temocillin within the OPAT setting. In jurisdictions where a <10% degradation limit is acceptable, once daily dosing with 24-hour continuous infusion may be considered. Temocillin is a useful alternative to other broad-spectrum anti-Gram-negative agents currently utilised in the OPAT setting and supports the wider antimicrobial stewardship agenda.
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Affiliation(s)
- Fekade Bruck Sime
- University of Queensland Centre for Clinical Research, Faculty of Medicine,the University of Queensland, Herston, Queensland, Australia
| | - Steven Wallis
- University of Queensland Centre for Clinical Research, Faculty of Medicine,the University of Queensland, Herston, Queensland, Australia
| | - Conor Jamieson
- Pharmacy Department, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | - Tim Hills
- Pharmacy Department and OPAT Service, Nottingham University Hospitals, Nottingham, UK, Bristol, UK
| | - Mark Gilchrist
- Department of Pharmacy/Infection, Imperial College Healthcare NHS Trust, London, UK
| | - Mark Santillo
- Quality Assurance, University Hospitals Plymouth NHS Trust, Plymouth, UK and University Hospitals Bristol and Weston NHS Trust, Bristol, UK, Bristol, UK
| | | | | | - Jason Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine,the University of Queensland, Herston, Queensland, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Queensland, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
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Petitjean G, Aman-Pommier F, Coudoré F, El Helali N, Le Monnier A. A rapid, automatic and accurate assay for quantifying temocillin in human serum and CSF using turbulent flow liquid chromatography coupled to high-resolution mass spectrometry. Clinical application. Biomed Chromatogr 2019; 34:e4759. [PMID: 31758604 DOI: 10.1002/bmc.4759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 11/10/2019] [Accepted: 11/19/2019] [Indexed: 11/11/2022]
Abstract
Temocillin is a β-lactamase-resistant penicillin used for the treatment of multiple drug-resistant Gram-negative bacteria. To maximize efficacy and avoid adverse effects, the dose regimen has to be quickly adjusted to the clinical situations. This necessitates the development of a rapid, reliable and accurate analytical method. Temocillin and the stable isotopically labeled internal standard ([13 C6 ]-amoxicillin) were extracted from either serum or cerebrospinal fluid by a turbulent flow liquid chromatographic method and eluted onto an octadecyl-silica phase with polar endcapping. Mass spectrometry was conducted using an exact mass determination method by electrospray positive ionization high-resolution mass spectrometry. The LLOQ and ULOQ of the present method were determined to be 0.4 and 200 μg/ml for serum and cerebrospinal fluid samples, respectively. The total analysis time was <7 min. The recovery ranged from 87.7 to 120.8%. Intra- and inter-day precision and trueness were tested at four concentration levels: 0.4, 8, 40 and 160 μg/ml. Values were 6.33 ± 1.53, 8.8 ± 1.3, 8.8 ± 0.36 and 2.1 ± 0.76%, and 5.0 ± 0.54, 9.9 ± 1.0, 5.8 ± 1.6 and 0.1 ± 1.1%, for inter- and intra-day analysis, respectively. Temocillin was found to be stable under all relevant laboratory conditions. The method was cross-validated with a microbiological assay. This method is suitable for accurate measurement of temocillin concentration in small volumes of serum or cerebrospinal fluid. Thanks to the online extraction procedure, the overall analytical time is compatible with high-throughput analysis for clinical application.
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Affiliation(s)
- Grégoire Petitjean
- Groupe Hospitalier Paris Saint-Joseph, Service de Microbiologie Clinique, Paris, France.,Plateforme de Dosage des Anti-Infectieux, Groupe Hospitalier Paris Saint-Joseph, Paris, France.,Université Paris-Sud, Université Paris-Saclay, Faculté de Pharmacie, UBaPS, EA, Chatenay-Malabry, France
| | - Fabrice Aman-Pommier
- Groupe Hospitalier Paris Saint-Joseph, Service de Microbiologie Clinique, Paris, France.,Plateforme de Dosage des Anti-Infectieux, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - François Coudoré
- Groupe Hospitalier Paris Saint-Joseph, Service de Microbiologie Clinique, Paris, France.,Plateforme de Dosage des Anti-Infectieux, Groupe Hospitalier Paris Saint-Joseph, Paris, France.,Faculté de Pharmacie, Inserm, CESP, UMR INSERM S 1178, Université Paris-Sud, Université Paris-Saclay, Chatenay-Malabry, France
| | - Najoua El Helali
- Groupe Hospitalier Paris Saint-Joseph, Service de Microbiologie Clinique, Paris, France.,Plateforme de Dosage des Anti-Infectieux, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Alban Le Monnier
- Groupe Hospitalier Paris Saint-Joseph, Service de Microbiologie Clinique, Paris, France.,Plateforme de Dosage des Anti-Infectieux, Groupe Hospitalier Paris Saint-Joseph, Paris, France.,Université Paris-Sud, Université Paris-Saclay, Faculté de Pharmacie, UBaPS, EA, Chatenay-Malabry, France
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Validation of a HPLC-MS/MS assay for the determination of total and unbound concentration of temocillin in human serum. Clin Biochem 2015; 48:542-5. [DOI: 10.1016/j.clinbiochem.2015.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/31/2015] [Accepted: 02/10/2015] [Indexed: 11/20/2022]
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