Table 2.
Summary of available in vitro and in vivo data on antibiotic lock solutions
| Antibiotic class/agent | Antibiotic concentrations | Additives and concentrations | Stability comments | Dwell time/duration (if applicable) | Type of investigation(s) |
|---|---|---|---|---|---|
| Penicillins | |||||
| Penicillin G25 | 50,000 units/mL | Heparin 2,500 and 5,000 units/mL | Visual confirmation of physical compatibility | Dwell time up to 72 hours between HD sessions; duration 2–3 weeks with systemic antibiotics | Case report |
| Ampicillin24, 84, 85 | 10 mg/mL | Heparin 10 and 5,000 units/mL | Physically stable (visual confirmation) for 14 days at 4°C and 37°C; yellow color reported at day 3; heparin stable for 14 days based on aPTT measures | In vitro bioactivity study | |
| 5 mg/mL | No additives | Case report | |||
| 2 mg/mL | Heparin 10 units/mL | Visual confirmation of physical compatibility | Dwell time up to 6 hours, solution aspirated then replaced to target continuous lock | In vivo study | |
| Amoxicillin25 | 5 mg/mL | Heparin 2,500 units/mL | Visual confirmation of physical compatibility | Dwell time up to 72 hours between HD sessions; duration 2–3 weeks with systemic antibiotics | Single case report |
| Piperacillin24–26 | 10, 20, 40 mg/mL | Heparin 10 and 5,000 units/mL | Physically stable (visual confirmation) for 14 days at 4°C and 37°C; yellow color reported at day 3 with piperacillin 40 mg/mL; heparin stable for 14 days based on aPTT measures with piperacillin 40 mg/mL | In vitro bioactivity study | |
| 100 mg/mL | Heparin 400 units/mL | Visual confirmation of physical compatibility | Dwell time up to 72 hours between HD sessions; duration 2–3 weeks with systemic antibiotics | Case report | |
| Piperacillin/tazobactam27 | 10 mg/mL | Heparin 100 units/mL | Visual confirmation of physical compatibility | Two case reports; dwell time of a minimum of 12 hours per day; duration of 10 days with systemic antibiotics | |
| Ticarcillin/clavulanate23 | 0.5 mg/mL | Heparin 100 units/mL | Bioassay stability sampling confirmed < 10% loss of activity at 10 days at 25°C and 37°C in polystyrene test tubes; addition of susceptible bacteria had no impact on stability | In vitro bioassay stability study | |
| Nafcillin86 | 83.3 mg/mL, 166.6 mg/mL | No additives | Visual confirmation of physical compatibility | Dwell time of 12 hours daily; average duration 8 days | Case series (6 reports) |
| Cloxacillin87 | 100 mg/mL | Heparin 1,000 units/mL | Visual confirmation of physical compatibility | Dwell time up to 96 hours between HD sessions | In vivo study |
| Mezlocillin88 | 2 mg/mL | No additives | Visual confirmation of physical compatibility | Dwell time 12–24 hours; duration 10–14 days | Case series (one report) |
| Flucloxacillin38 | 20 mg/mL | Heparin 10–10,000 units/mL | Visual precipitation testing grid; authors comment that “low-dose heparin” showed precipitation at 48 hours at 25°C and 37°C; combination with heparin 4,000 units/mL stable for 72 hours | In vitro bioactivity study | |
| Cephalosporins | |||||
| Cefazolin20,21,23,24,45,84,89–96 | 10 mg/mL | Heparin 10 and 5,000 units/mL | Physically stable (visual confirmation) for 14 days at 4°C; and 37°C; yellow color reported; heparin stable for 14 days based on aPTT measures | In vitro bioactivity study | |
| 10 mg/mL | Heparin 5,000 units/mL | < 10% change in absorbance at 72 hours in glass tubes; 27.3% change in absorbance at 72 hours in polyurethane catheter | In vitro stability study | ||
| 5 mg/mL | Gentamicin 5 mg/mL and heparin 1,000 and 5,000 units/mL | Visual confirmation of physical compatibility; combination with heparin 5,000 units/mL confirmed to 72 hours at 37°C – a haze reported when prepared at room temperature within 30 minutes | In vivo study; in vitro model of CRSBI | ||
| 5 mg/mL | TPA 1 mg/mL | Visual confirmation of physical compatibility up to 48 hours | In vivo study | ||
| 5 mg/mL | Heparin 5,000 units/mL | Visual confirmation of physical compatibility up to 72 hours | Dwell time up to 72 hours between HD sessions; duration up to 2 weeks | In vitro and animal models of CRBSI; in vivo study | |
| 5 mg/mL | Gentamicin 1 mg/mL and heparin 2,500 units/mL | Visual confirmation of physical compatibility up to 72 hours at 25°C and 37°C | Dwell time up to 72 hours between HD sessions | In vivo study; animal model of CRSBI | |
| 5 mg/mL | Heparin 2,500 units/mL | Visual confirmation of physical compatibility up to 72 hours | In vivo study | ||
| 5 mg/mL | Heparin 10 units/mL | Visual confirmation of physical compatibility | Dwell time up to 72 hours between HD sessions | In vivo study | |
| 0.5 mg/mL | Heparin 100 units/mL | Bioassay stability sampling confirmed ≤ 10% loss at 10 days at 25°C and 37°C in polystyrene test tubes; addition of susceptible bacteria had no impact on stability | Dwell time up to 72 hours between HD sessions | In vitro bioassay stability study | |
| Ceftazidime21–23,86,95,97,98 | 0.5 mg/mL | Heparin 100 units/mL | Bioassay stability sampling confirmed < 10% loss of activity at 3 days at 25°C and 37°C in polystyrene test tubes; 30%–38% loss of activity at 7 days at 37°C | Dwell time of 8–12 hours/day; duration 7–14 days | In vitro bioassay stability study; in vivo study |
| 2 mg/mL | Heparin 100 units/mL | Concentrations from aspirated lock after ≤ 15 days and ≤21 days in situ remained 234 μg/mL and 110 μg/mL, respectively | Continuous dwell times of 2–34 days (median =17 days) | In vivo study with residual antibiotic concentration analysis | |
| 2.5 mg/mL | Vancomycin 2.5 mg/mL and heparin 2,500 units/mL | Visual confirmation of physical compatibility | Dwell time up to 72 hours between HD sessions | In vivo study | |
| 5 mg/mL | Heparin 2,500 units/mL | Visual confirmation of physical compatibility; authors state up to 72 hours at 37°C (unpublished) | Dwell time up to 72 hours between HD sessions | In vivo study | |
| 10 mg/mL | Heparin 5,000 units/mL | 10.6%–12.9% change in absorbance at 48 and 72 hours at 37°C in glass tubes, respectively; 31.9%–40.2% change at 48 and 72 hours in polyurethane catheters, respectively | In vitro stability study | ||
| 83.3 mg/mL, 166.6 mg/mL, and 333 mg/mL | No additives | Dwell time of 12 hours daily; average duration of 8 days | Case series | ||
| Ceftriaxone86 | 83.3 mg/mL, 166.6 mg/mL | No additives | Dwell time of 12 hours daily; average duration of 8 days | Case series | |
| Cefotaxime99–104 | 10 mg/mL | Heparin 5,000 units/mL | Visual confirmation of physical compatibility; one study stored lock solutions under refrigeration prior to instillation in HD port. Chemical/physical stability confirmed at 4°C; > 10% degradation at 24 hours at 27°C and 40°C | Dwell time up to 72 hours between HD sessions | In vivo study; in vitro stability study |
| Carbapenems | |||||
| Imipenem/cilastatin29 | 50 mg/mL | Heparin | Visual confirmation of physical compatibility | In vivo study | |
| Fluoroquinolones | |||||
| Ciprofloxacin23,29,38,68,95,105,106 | 0.100 mg/mL | Heparin 5,000 units/mL (reported as 5% heparin sodium) | Visual confirmation of physical compatibility | Dwell time up to 72 hours between HD sessions; duration of 15 days | In vivo study |
| 0.125 mg/mL | Heparin 100 units/mL | Bioassay stability sampling confirmed no loss of activity at 10 days at 25°C and 37°C in polystyrene test tubes; addition of susceptible bacteria had no impact on stability; ciprofloxacin concentrations >0.125 μg/mL formed visual precipitation with heparin | In vitro bioassay stability study | ||
| 0.1–1 mg/mL | Heparin 10–10,000 units/mL | Visual stability at 7 days at 25°C and 37°C in glass tubes confirmed for the following combinations: ciprofloxacin 0.1 mg/mL + heparin 10–10,000 units/mL; ciprofloxacin 0.2 mg/mL + heparin 1,000–10,000 units/mL; ciprofloxacin 0.4–0.6 mg/mL + heparin 5,000–10,000 units/mL | In vitro stability study | ||
| 0.1–1 mg/mL | Teicoplanin 0.1–4 mg/mL + heparin 7–10,000 units/mL | Visual stability at 7 days at 25°C and 37°C in glass tubes confirmed for the following combinations: teicoplanin 0.1 mg/mL + ciprofloxacin 0.1 mg/mL + heparin 7–10,000 units/mL; teicoplanin 0.2 mg/mL + ciprofloxacin 0.2 mg/mL + heparin 700–10,000 units/mL; teicoplanin 0.4–2.0 mg/mL + ciprofloxacin 0.4 mg/mL + heparin 3,500–10,000 units/mL; teicoplanin 4 mg/mL + ciprofloxacin 0.8 mg/mL + heparin 10,000 units/mL | In vitro stability study | ||
| 0.2–0.8 mg/mL | Sodium citrate 22 g/L | Authors report visual stability at 7 days at 25°C and 37°C in glass tubes | In vitro stability study | ||
| 0.4–0.6 mg/mL | Teicoplanin 4 mg/mL + sodium citrate 22 g/L | Visual stability confirmed at 7 days at 25°C and 37°C in glass tubes for ciprofloxacin 0.4 mg/mL in combination | In vitro stability study | ||
| 1 mg/mL | Heparin 2,500 units/mL | < 10% variability at 72 hours at 37°C in glass tubes | In vitro bioassay stability study | ||
| 2 mg/mL | Heparin | Visual confirmation of physical compatibility | Dwell time up to 72 hours between HD sessions | In vivo study | |
| 10 mg/mL | No additives | < 10% variability at 10 days at 37°C in glass tubes | In vitro bioassay stability study | ||
| 10 mg/mL | Heparin 5,000 units/mL | Immediate precipitation | In vitro stability study | ||
| Levofloxacin27,47 | 0.05, 3.2 mg/mL | Clarithromycin 200 mg/mL ± heparin 1,000 units/mL | Visual confirmation of compatibility at 96 hours at 37°C | In vitro stability and bioactivity study | |
| 5 mg/mL | Heparin 100 units/mL | Precipitation noted; levofloxacin 5 mg/mL used without additive | Dwell time minimum of 12 hours/day, changed daily; Duration of 7–14 days | Case series | |
| Aminoglycosides | |||||
| Amikacin18,19,38,40,65,66,68,70,88,107–109 | 0.02–4 mg/mL | Teicoplanin 0.02–10 mg/mL ± heparin 7–10,000 units/mL | Visual stability at 7 days at 25°C and 37°C in glass tubes confirmed for the following combinations: teicoplanin 0.02–0.5 mg/mL + amikacin 0.02–0.05 mg/mL; teicoplanin 0.02–2 mg/mL + amikacin 0.02–3 mg/mL + heparin 700–10,000 units/mL; teicoplanin 4–10 mg/mL + amikacin 0.02–3 mg/mL + heparin 3,000–10,000 units/mL | In vitro stability study | |
| 1 mg/mL | No additives | Dwell time of 24 hours, changed daily; duration of 5 days | In vivo study | ||
| 1.5 mg/mL | No additives | Bioactivity reported by authors up to 14 days stored at 4°C | Dwell time 12 hours/day; changed daily; duration of 14 days | In vivo study | |
| 2 mg/mL | No additives | Dwell time of 12 hours/day; changed every 12 hours; duration 10–14 days | Case report | ||
| 2 mg/mL | Heparin 20 units/mL | Visual confirmation of physical compatibility | Dwell time minimum of 72 hours; duration of 3–14 days | In vivo study | |
| 5 mg/mL | No additives | Dwell time 12–24 hours; duration 11 days | Case report | ||
| 5 mg/mL | Vancomycin 5 mg/mL + heparin 5,000 units/mL | Visual confirmation of physical compatibility | Dwell time of 72 hours; duration of 3 days | In vivo study | |
| 10 mg/mL | Heparin 5,000 units/mL | Visual confirmation of physical compatibility | Dwell time up to 72 hours between HD sessions | Case report | |
| 20 mg/mL | No additives | Dwell time 12–24 hours; duration 3 days | In vivo study | ||
| 40 mg/mL | Heparin 100 units/mL | Visual confirmation of physical compatibility | Continuous dwell changed every 8 hours; duration of 14 days | In vivo study | |
| Gentamicina,34,38,45,48,63,95,110,111 | 0.1 mg/mL | Heparin 5,000 units/mL | At 4°C, compatible and stable for up to 4 weeks; confirmed via particle-enhanced turbidimetric inhibition immunoassay | In vitro stability study | |
| 0.32 mg/mL | Citrate 40 mg/mL | Visual confirmation of physical compatibility | Dwell time up to 72 hours between HD sessions | In vivo study | |
| 0.02–2 mg/mL | Teicoplanin 0.02–2 mg/mL + heparin 7–10,000 units/mL | At 25°C and 37°C, gentamicin 0.02 and teicoplanin 0.02 compatible at all heparin concentrations; gentamicin 0.2–1 mg/mL, teicoplanin 0.2–1 mg/mL + heparin 3,500–10,000 units/mL compatible for 7 days | In vitro stability and bioactivity study | ||
| 1 mg/mL | Heparin 2,500 units/mL + vancomycin 2.5 mg/mL + cefazolin 5 mg/mL | Compatibility confirmed at 37°C for 72 hours | Dwell time up to 72 hours between HD sessions | In vivo study | |
| 2, 4 mg/mL | Teicoplanin 4 mg/mL + citrate 22 g/dL | Gentamicin 2 mg/mL + teicoplanin 4 mg/mL + citrate compatible at 37°C for 7 days | In vitro stability study | ||
| 2.5 mg/mL | Heparin 10 units/mL | Visual confirmation of physical compatibility | Dwell time 12–24 hours; duration up to 15 days | Case series | |
| 2.5 mg/mL | Citrate 40 mg/mL | At 37°C, no decrease in gentamicin or citrate concentration at 96 hours; at room temperature, 100% of gentamicin and 101.3% citrate retained for 112 days | In vitro stability studies | ||
| 3 mg/mL | Daptomycin 1 mg/mL + citrate 28 mg/mL + LR | Refer to Daptomycin section in this table | In vitro stability study | ||
| 5 mg/mL | EDTA 30 mg/mL | Visual confirmation of physical compatibility for 72 hours in glass tubes at 25°C and 37°C | Dwell time 12–24 hours | In vitro bioactivity study; animal model | |
| 5 mg/mL | Heparin 10 units/mL | Visual confirmation of physical compatibility | In vitro bioactivity study | ||
| 5 mg/mL | Heparin 1,000 units/mL | Visual confirmation of physical compatibility | Dwell time 12–24 hours; duration up to 15 days | Case series; in vivo study | |
| 5 mg/mL | Heparin 5,000 units/mL | 92% of gentamicin concentration retained at 72 hours | Dwell time 12–24 hours; duration up to 15 days | In vitro stability study | |
| 5 mg/mL | Vancomycin 10 mg/mL+ heparin 10–5,000 units/mL | Mild haziness on preparation, dissipated with time and warming | Dwell time 12–24 hours; duration up to 15 days | Case series | |
| Tobramycin20,34,36,112 | 2.4 mg/mL | Sodium citrate 40 mg/mL | Stability and compatibility confirmed at 48 hours at 23°C and 37°C | In vitro stability study | |
| 5 mg/mL | TPA 0.875 mg/mL | Stability and compatibility confirmed at 12 hours room temperature | Dwell times of 72 hours with HD sessions | In vivo study; case series | |
| 5 mg/mL | TPA 1 mg/mL | Visual confirmation of physical compatibility up to 48 hours | In vivo study | ||
| Glycopeptides | |||||
| Vancomycina,20,22,23,39,40,46,70,95,104,106,107,110,113–121 | 0.025 mg/mL | Heparin 9.75 units/mL | At 4°C or room temperature, vancomycin concentrations stable for 40 days | Dwell times variable in neonates | In vitro bioassay stability study; in vivo study |
| 0.025 mg/mL | Heparin 100 units/mL | At 4°C, vancomycin concentration stable for 14 days; at 37°C, concentration reduced by 15%–37% at 24 hours | In vitro stability study; in vivo study | ||
| 0.025 mg/mL | Heparin 5,000 units/mL | At 4°C and 27°C, compatible and stable for 72 hours; at 40°C, 81 % of vancomycin concentration retained at 72 hours | Dwell times variable in adult cancer patients | In vitro stability study; in vivo study | |
| 0.1 mg/mL | Heparin 5,000 units/mL | At 4°C, compatible and stable for up to 4 weeks | In vitro stability study | ||
| 0.1 mg/mL | Colistin 0.1 mg/mL + heparin 100 units/mL | Refer to Colistin section in this table | In vitro stability study | ||
| 0.5 mg/mL | Heparin 100 units/mL | Bioassay stability sampling confirmed < 10% loss of activity at 10 days at 25°C and 37°C in polystyrene test tubes; addition of susceptible bacteria and no impact on stability | In vitro bioassay stability study | ||
| 1 mg/mL | No additives | Bioactivity reported by authors up to 14 days stored at 4°C | Dwell time 12 hours/day; changed daily; duration of 14 days | In vivo study | |
| 1 mg/mL | Citrate 40 mg/mL | At 4°C, RT, or 37°C, >92% of vancomycin concentration at 72 hours with storage in polyvinyl chloride syringes of HD catheters | In vitro stability study | ||
| 2 mg/mL | Heparin 20 units/mL | Visual confirmation of compatibility; prepared every 3 days and stored at 4°C | Dwell times of 8–12 hours per day; duration of 14 days | In vivo study | |
| 2 mg/mL | Heparin 100 units/mL | Vancomycin concentration of ≥0.130 mg/mL retained for up to 28 days | Dwell time 4–28 days in ports of patients | In vivo studies | |
| 2 mg/mL | Heparin 2,500 units/mL | At 37°C, stable for at least 72 hours and physically compatible; at 37°C, >90% of vancomycin concentration over 72 hours | In vitro stability studies | ||
| 2 mg/mL | Citrate 22 mg/mL | Initial precipitation, but no precipitation noted after 10 minutes of incubation at 37°C; >90% of vancomycin concentration over 72 hours | In vitro stability study | ||
| 2 mg/mL | Citrate 40 mg/mL | Physically compatible; at 37°C, >90% of vancomycin concentration retained over 72 hours | In vitro stability study | ||
| 2.5 mg/mL | Heparin 2.5 units/mL | Decrease in vancomycin concentration gradient from proximal to distal segments of dialysis catheter at 48 hours | Dwell time 48 hours in HD catheters | In vivo study with drug concentration analysis | |
| 3 mg/mL | No additives | In vivo study | |||
| 3 mg/mL | Citrate 40 mg/mL | At 4°C, RT, or 37°C, >92% of vancomycin concentration at 72 hours with storage in polyvinyl chloride syringes of HD catheters | In vitro stability study | ||
| 5 mg/mL | TPA 1 mg/mL | Visual confirmation of physical compatibility up to 48 hours | In vivo study | ||
| 5 mg/mL | No additives | Dwell times of 48 hours; duration of 7 days | In vivo study | ||
| 5 mg/mL | Heparin 2,500 units/mL | At 37°C, >90% of vancomycin concentration at 72 hours and physically compatible | In vitro stability study | ||
| 5 mg/mL | Citrate 22 mg/mL | Initial precipitation, but no precipitation noted after 10 minutes of incubation at 37°C; >90% of vancomycin concentration over 72 hours | In vitro stability study | ||
| 5 mg/mL | Citrate 40 mg/mL | Physically compatible; at 37°C, >90% of vancomycin concentration retained over 72 hours | In vitro stability study | ||
| 10 mg/mL | Heparin 5,000 units/mL | In glass test tubes stored at 37°C, no change in vancomycin concentration over 72 hours; in CVCs, concentration decreased by 29.7% over 72 hours | In vitro stability study; in vivo study | ||
| 10 mg/mL | Gentamicin 8 mg/mL + heparin 5,000 units/mL | Visual confirmation of physical compatibility | Dwell times up to 72 hours between HD sessions; duration of 2 weeks | In vivo study | |
| Teicoplanin38,122,123 | 0.02–10 mg/mL | Heparin 10–10,000 units/mL | Visual compatibility confirmed at 7 days at 25°C and 37°C in glass tubes | In vitro stability study | |
| 0.1–4.0 mg/mL | Ciprofloxacin 0.1–1 mg/mL + heparin 7–10,000 units/mL | See ciprofloxacin section | In vitro stability study | ||
| 0.02–2.0 mg/mL | Gentamicin 0.02–2 mg/mL + heparin 7–10,000 units/mL | Refer to Gentamicin section in this table | In vitro stability study | ||
| 0.02–10 mg/mL | Amikacin 0.02–4 mg/mL + heparin 7–10,000 units/mL | Refer to Amikacin section in this table | In vitro stability study | ||
| 4 mg/mL | Ciprofloxacin 0.4–0.6 mg/mL + sodium citrate 22 mg/mL | Refer to Ciprofloxacin section in this table | In vitro stability study | ||
| 4 mg/mL | Gentamicin 2–4 mg/mL + sodium citrate 22 mg/mL | Refer to Gentamicin section in this table | In vitro stability study | ||
| 10 mg/mL | Heparin 5,000 units/mL | Visual confirmation of physical compatibility | Dwell time up to 72 hours between HD sessions; duration of 21 days | In vivo study | |
| Telavancin39 | 2, 5 mg/mL | Heparin 2,500 units/mL | Physical and chemical stability at 72 hours at 37°C; aPTT increased in 5 mg/mL solution | ||
| 2, 5 mg/mL | Citrate 22 mg/mL, 0 mg/mL | Physical and chemical stability at 72 hours at 37°C | In vitro stability study | ||
| Oxazolidinones | |||||
| Linezolid34,37,38,113 | 0.2–1.92 mg/mL | Heparin 10–10,000 units/mL | Visual compatibility confirmed at 7 days at 25°C and 37°C in glass tubes | In vitro stability study | |
| 1 mg/mL | Citrate 20 mg/mL | Confirmation of physical stability based on visual changes, absorbance, and pH for 48 hours at 23°C and 37°C in glass tubes | In vitro stability study | ||
| 2 mg/mL | Heparin 100 units/mL | Visual confirmation of physical compatibility | Dwell time of 8 hours; duration of 20 days | Case report | |
| 2 mg/mL | Heparin 2,000 units/mL | Visual confirmation of physical compatibility | Dwell time up to 72 hours between HD sessions | In vivo study | |
| Lipopeptides | |||||
| Daptomycin34,45,64,124–127 | 1 mg/mL | Heparin 5,000 units/mL (reconstituted in 0.9% NS and LR) | Visual compatibility confirmed at 72 hours at 25°C and 37°C in glass tubes | In vitro bioactivity study | |
| 1 mg/mL | Heparin 100–1,000 units/mL | Visual compatibility confirmed for preparation | Dwell times 12–24 hours; duration up to 15 days | In vivo study | |
| 1 mg/mL | Gentamicin 3 mg/mL + citrate 28 mg/mL + LR | At 25°C, 90.7% and 86.7% of daptomycin concentration retained at 48 and 72 hours, respectively; 95.2% of gentamicin concentration retained at 96 hours | In vitro stability study | ||
| 2.5 mg/mL | Ethanol 25% | Visual confirmation of physical compatibility | In vitro bioactivity study | ||
| 5 mg/mL | Heparin 100 units/mL (reconstituted in LR) | <5% decrease in daptomycin and heparin concentrations at 14 days at 4°C and −20°C in polypropylene syringes | In vitro stability study; in vivo study | ||
| 5 mg/mL | Citrate 4% (supplemented with calcium chloride 50 μg/mL) | Confirmation of physical stability based on visual changes, absorbance, and pH for 48 hours at 23°C and 37°C in glass tubes | In vitro stability study | ||
| 5 mg/mL, 25 mg/mL | Heparin 5, 5,000, 10,000 units/mL (reconstituted in LR) | < 10% decrease in daptomycin concentration at 24 hours at 37°C | In vitro bioactivity and stability study; in vivo study | ||
| Tetracyclines | |||||
| Minocycline40–42,69,70,128,129 | 0.2 mg/mL | Bioactivity reported by authors up to 4 days stored at 4°C | Dwell time 12 hours/day; changed daily; duration of 14 days | In vivo study | |
| 2–3 mg/mL | EDTA 30 mg/mL ± ethanol 25% | Visual compatibility confirmed | Dwell times up to 7 days used | In vitro bioactivity study; in vivo study | |
| Glycylcyclines | |||||
| Tigecycline45,130,131 | 0.5 mg/mL | EDTA 30 mg/mL | Visual compatibility confirmed at 48 hours at 25°C and 37°C in glass tubes; color change detected after 48 hours | In vitro bioactivity study | |
| 1 mg/mL | NAC 80 mg/mL + heparin 2,000 units/mL (heparin 100 units/mL in single case report) | Visual compatibility confirmed; samples stored at −21°C until use | Dwell times 12–72 hours; duration 14 days | In vivo study; case report | |
| Folate antagonists | |||||
| Sulfamethoxazole/trimethroprim27,128 | 10, 16 mg/mL (based on TMP component) | Heparin 100 units/mL | Visual confirmation of physical compatibility for up to 14 days (16 mg/mL solution) | In vivo study | |
| Trimethoprim128,132 | 5, 10 mg/mL | EDTA 30 mg/mL + ethanol 25% (referred to as “B-lock”) | Visual confirmation of physical compatibility | In vitro bioactivity study | |
| Polymyxins | |||||
| Colistin46,47 | 0.1 mg/mL | Vancomycin 0.1 mg/mL + heparin 100 units/mL | Compatibility and stability confirmed; < 10% degradation at 60 days at 4°C and 25°C; vancomycin had ~25% decrease in concentrations after day 15 at room temperature | In vitro stability study | |
| 0.8 mg/mL | Clarithromycin 200 mg/mL ± heparin 1,000 units/mL | Visual confirmation of physical compatibility at 96 hours | In vitro bioactivity study | ||
Note:
a
Several published reports of gentamicin and vancomycin were not included in the table due to duplication of concentrations.
Abbreviations: aPTT, activated partial thromboplastin time; CRBSI, catheter-related bloodstream infection; CVC, central venous catheter; EDTA, ethylenediaminetetraacetic acid; HD, hemodialysis; LR, lactated ringer's solution; NAC, N-acetylcysteine; NS, normal saline; RT, room temperature; TPA, tissue plasminogen activator; TMP, trimethoprim.