Stability of 90 mg/mL cefuroxime sodium solution for administration by continuous infusion

Physicochemical stability of high-concentration cefuroxime aqueous injection reconstituted by a centralised intravenous additive service

OBJECTIVES

Hospital pharmacies provide centralised intravenous additive services (CIVAS), such as antibiotic reconstitution. The aim of this study was to demonstrate the physicochemical stability of high-concentration cefuroxime sodium in aqueous injections, which is mandatory for the centralised preparation of products with automation.

METHODS

The physicochemical stability of three high-concentration injections (1.5 g of cefuroxime sodium in 15 mL, 16 mL and 18 mL of water for injection (WFI)) were studied in two primary packing materials (glass vials and polypropylene syringes). The samples were reconstituted with automation in three mid-sized hospital pharmacies in a good manufacturing practice (GMP) grade A/B cleanroom. During the study, the samples were stored in refrigerated conditions (4°C) and 1.5 g/15 mL solution in ambient temperature (22°C). Cefuroxime and descarbamoyl cefuroxime were analysed by high-performance liquid chromatography with UV detection. In addition, the appearance, pH and uniformity of dosage units were investigated.

RESULTS

The freshly prepared cefuroxime injections fulfilled the criteria of content uniformity (acceptance value (AV) <15). A significant decrease in concentration of cefuroxime and increase in content of descarbamoyl cefuroxime was observed in all injections. Cefuroxime aqueous injections were physiochemically stable for up to 14 days under refrigeration storage. The relative content of descarbamoyl cefuroxime remained under 3% at 4°C. The solution of 1.5 g/15 mL was stable for only 20 hours in formulations stored for the first 14 days at 4°C and then transferred to 22°C. The colour of the solution changed from light yellow to a darker yellow, and the pH value of the solutions increased during storage. Neither primary packing materials, commercial source of cefuroxime sodium nor exposure to light had any significant effect on the stability of formulations.

CONCLUSIONS

Although limited, we found the shelf life of high-concentration cefuroxime injections in refrigerated conditions sufficient for centralised antibiotic preparation in hospital pharmacy with automation. The limited shelf life of high-concentration cefuroxime injections must be considered when using these formulations.

A fast, cost-saving and sensitive method for determination of cefuroxime in plasma by HPLC with ultraviolet detection

Cefuroxime (CFX) is a broad-spectrum second-generation cephalosporin and one of the best choices for antibiotic prophylaxis. However, when used in critically ill patients, it may present changes in its pharmacokinetic properties. Therefore, therapeutic drug monitoring of CFX is necessary for effective dosing strategies. A simple, rapid and sensitive liquid chromatographic method with UV detection was developed and validated for the quantification of CFX in plasma. The method involved a single-step precipitation of proteins with methanol and trifluoroacetic acid. Cefuroxime was analyzed on a Brisa LC² C₁₈ column in isocratic mode consisting of 0.1% trifluoroacetic acid in water and acetonitrile (75:25) with UV detection at a wavelength of 280 nm. The retention times of CFX and cephazolin (internal standard) were 9.8 and 7.4 min, respectively. The calibration curve was linear over a concentration range of 0.25-50 μg/ml. The limits of detection and quantification were 0.1 μg/ml and 0.25 μg/ml, respectively. The accuracy and precision were always <10%. The mean recovery was 93.52%. This fast and simple method could be applied in routine analysis and pharmacokinetic studies.

Antimicrobial Stewardship: From Bedside to Theory. Thirteen Examples of Old and More Recent Strategies from Everyday Clinical Practice

“Antimicrobial stewardship” is a strategy that promotes the responsible use of antimicrobials. The objective of this paper is to focus on consolidated and more recent improvements in clinical strategies that should be adopted in hospitalized patients to ameliorate their infectious diseases’ outcome and to reduce the antibiotic resistance risk through judicious use of antibiotics. We present 13 common clinical scenarios, the respective suggested interventions and the explanations of the supporting evidence, in order to help clinicians in their decision-making process. Strategies including the choice of antibiotic and dose optimization, antibiotic spectrum narrowing (de-escalation), shortening of duration, shift to oral route or outpatient parenteral antibiotic (including elastomeric pumps), and biomarkers are described and discussed.