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JOHORE

ANTIBIOTICS DILUTION
QUICK REFERENCE
2011

1st Edition
Introduction

To promote and ensure the quality use of antibiotics, many strategies have been implemented such as good
infection control practices, conduct of multidisciplinary antibiotic rounds, establishment of national antimicrobial guideline,
surveillance programmes, audits, continuous training and education amongst health personnel.

Nevertheless, dilution of antibiotics is an essential part to ensure that patients receive the optimum therapy. It is
important that the concentration of antibiotics’ dilution is correct to minimize the side effects. Besides, stability of the
antibiotics is essential to ensure safety, quality and efficacy of the drugs.

This Johore Antibiotics Dilution Quick Reference 2011 is produced to standardize the practice among all
pharmacists in Johore state. Our aim is to provide comprehensive information regarding antibiotics dilution. It remains the
responsibility of every pharmacists to evaluate the appropriateness of a particular opinion or therapy in the context of
actual clinical situation and with due consideration of any new developments in the fields.

The use of this manual requires knowledge based interpretation by health care professionals and is intended solely
for use by pharmacists in healthcare facilities. All information contained in this manual has been provided with the sole
intent that it be readily accessible for pharmacist’s information and as a guide for conducting dilution of drugs that may be
prescribed.
Advisor
Pn. Rosidah bt. Md.Din - Deputy Director of Health (Pharmacy) Johore
Johore Pharmaceutical Services Division

Contributors :
Steril/Non-Steril Preparation Working Committee Members, Johore Pharmaceutical Services Division.

Pn. Hamidah bt. Arsal - Chief Pharmacist, Kluang Hospital

Pn. Eyatul Mazuin Ayla bt. Mamdooh Waffa - Pharmacist U48, Hospital Sultanah Aminah, Johor Bahru

Cik Ng Chau Tee - Pharmacist U44, Hospital Batu Pahat

Pn. Nurulhieda bt. Ab. Jamal - Pharmacist U44, Hospital Kluang

Cik So Yeong Zu - Pharmacist U41, Hospital Sultan Ismail, Johor Bahru

Pn. Azalilah bt Shaari - Assistant Director of Pharmacy (Practice & Development),


Johore Pharmaceutical Services Division.
CONTENT
No. Antibiotics Page
1. Acyclovir 250 mg 1
2. Amikacin 250 mg/2mL, 500 mg/2Ml 1
3. Amoxicillin 1 g + Clavulanate 200 mg 1
4. Ampicillin 500 mg 2
5. Ampicillin 1 g + Sulbactam Sodium 500 mg 2
6. Amphotericin B 50 mg 3
7. Azithromycin 500 mg 3
8. Benzathine Benzylpenicillin 2.4 MIU/5 ml 3
9. Benzylpenicillin 1 MIU, 5 MIU 4
10. Caspofungin Acetate 50 mg/70 mg 4
11. Cefepime 1 g 4
12. Cefoperazone 1g 5
13. Cefoperazone 500 mg + Sulbactam 500 mg 5
14. Cefotaxime 1g 6
15. Ceftazidime 1 g 6
16. Ceftriaxone 1 g 7
17. Cefuroxime 750 mg 7
18. Ciprofloxacin 200 mg/100 ml 8
19. Clindamycin Phosphate 150 mg/ml 8
No. Antibiotics Page
20. Cloxacillin Sodium 500 mg 8
21. Doripenem Monohydrate 500 mg 9
22. Erythromycin Lactobionate 500 mg 9
23. Fluconazole 100 mg/50ML 10
24. Fusidic Acid 500 mg 10
25. Gentamicin 80 mg/2 ml 10
26. Imipenem 500 mg + Cilastatin 500 mg 11
27. Linezolid 600 mg/300 ml 11
28. Meropenem 500 mg, 1g 11
29. Metronidazole 500 mg/100 mL 12
30. Moxifloxacin 400 mg/250 ml 12
31. Piperacillin 4 g + Tazobactam 500 mg 12
32. Polymycin B 500,000 IU 12
33. Streptomycin Sulphate 1g 13
34. Sulfamethoxazole 400 mg+ Trimethoprim 80 mg 13
35. Teicoplanin 200 mg 13
36. Tigecycline 50 mg 14
37. Vancomycin 500 mg 14
Abbreviations & References 15
Johore Antibiotics Dilution Quick Reference 2011

No Medication Diluent Administration Reconstitution/Dilution Final Stability


Concentration
1. Acyclovir 250 mg D5W Intermittent IV infusion: Reconstitute 250 mg with 10 Intermittent IV Reconstituted solution 25
NS Over a minimum of 1 hr ml WFI: 25 mg/ml infusion: ≤ 5 mg/ml:
Lactate Ringer’s NOT for IM or subQ mg/ml 12 hrs (RT)
Hartmann’s administration Intermittent IV infusion:
Gluc-NaCI Withdraw required dose and Prepared infusion ≤ 5
further dilute concentration ≤ mg/ml :
5 mg/ml with diluents 24 hrs (RT)
(usually NS)
Do not refrigerate, may
dose ≤ 500 mg to 100 ml precipitate
dose > 500 mg to 250 ml

2. Amikacin D5W IM (preferred route): IM & IV injection: 0.25 – 5mg/ml Prepared infusion
250 mg/2mL NS Deep IM into upper outer Withdraw required dose 0.25 – 5 mg/ml:
500 mg/2mL Hartmann’s quadrant of buttocks. without further dilution. 24 hrs (RT)
Lactate Ringer’s 2 days (2-8ºC)
IV injection: Intermittent IV infusion:
Over 2-3 min Withdraw required dose and Unused portion in vial
further dilute to 0.25 – should be discarded
Intermittent IV infusion: 5mg/ml with diluents. (usually
Adult: over 30 – 60 min 100 ml NS) Protect from light and do
Infant: 1-2 hrs not freeze

3. Amoxicillin 1 g + NS IV injection: Reconstitute 1.2 g with 20 ml IV injection: Reconstituted vials &


Clavulanate 200 mg Over 3-4 min WFI: 60 mg/ml 60 mg/ml prepared infusion:
Incompatible with Used immediately.
D5W Intermittent IV infusion: IV injection: Intermittent IV
Over 30-40 min Withdraw required dose infusion: Use within 3 hrs in 25°C
without further dilution. 12 mg/ml after preparation

Intermittent IV infusion:
Withdraw required dose and
further dilutes to with
diluents.
Dose 1.2 g in 100 ml NS

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Concentration
4. Ampicillin NS IM IM administration: IM: Reconstituted vials:
500 mg Reconstitute 500 mg with 1.8 250 mg/ml Used immediately
IV injection: ml WFI: 250 mg/ml.
Incompatible with Over 3-5 min Withdraw required dose IV injection: IM & IV injection:
D5W & Hartmann’s without further dilution 100 mg/ml Use within 1 hr after
Intermittent IV infusion: preparation.
Over 30-60 min IV administration: Intermittent IV
Reconstitute 500 mg with 5 infusion:
ml WFI: 100 mg/ml ≤ 30 mg/ml Prepared infusion in NS:
8 hrs (RT)
IV injection: 12 hrs (2-8ºC)
Withdraw required dose
without further dilution

Intermittent IV infusion:
Withdraw required dose and
add to suitable volume of
diluents.
Dose ≤ 1g to 50 ml
Dose >1g to 100 ml

5. Ampicillin 1 g + NS IM Reconstitute 1.5 g with 3.2 IM & IV injection: Prepared IM/ IV injection:
Sulbactam Sodium D5W ml WFI: 375 mg/ml 375 mg/ml Use within 1 hr after
500 mg IV injection: preparation
Over 10-15 min IM & IV injection: 375 mg = 250 mg
0.5% or 2% Withdraw required dose ampicillin + 125 mg Prepared infusion in NS:
lidocaine Intermittent IV infusion: without further dilution. sulbactam 8 hrs (RT)
hydrochloride for Over 15 - 30 min 72 hrs (2-8ºC)
IM administration Intermittent IV infusion: Intermittent IV
only Withdraw required dose and infusion: Prepared infusion in D5W:
further dilute with 50 – 100 3 – 45 mg/ml 2 hrs (RT)
ml diluent. 4 hrs (2-8ºC)
3 mg/ml = 2 mg
ampicillin + 1 mg
sulbactam

45 mg = 30 mg
ampicillin + 15 mg
sulbactam

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Concentration
6. Amphotericin B D5W Intermittent IV infusion: Reconstitute 50 mg with 10 Peripheral Reconstituted solution 5
50 mg Over 20-30 min (test ml WFI: 5 mg/ml infusion: mg/ml:
dose) ≤ 0.1 mg/ml 24 hrs (RT)
Incompatible with Over 4 to 6 hrs or longer if Withdraw required dose and 7 days (2-8ºC)
NS and all not tolerated. further dilute to: Central infusion:
electrolyte 500 ml, ≤ 0.1 mg/ml ≤ 0.25 mg/ml Prepared infusion:
solutions Flush line again with D5W 250 ml, ≤ 0.25 mg/ml 24 hrs (RT)
after infusion complete 2 days (2-8ºC)

Protect from light

7. Azithromycin NS Intermittent IV infusion: Reconstitute 500 mg with 4.8 1 – 2 mg/ml Reconstituted solution:
500 mg D5W Over 3 hrs (1 mg/ml) ml WFI: 100 mg/ml 24 hrs (< 30ºC)
Lactated Ringer’s Over 1 hr (2 mg/ml)
Intermittent IV infusion: Prepared infusion 1-2
Minimum duration of 1 hr. Reconstituted solution 100 mg/ml:
mg/ml further dilute with 24 hrs (RT)
NOT for IM or IV bolus diluents to: 7 days (2-8ºC)
administration 500 ml, 1 mg/ml
250 ml, 2 mg/ml

8. Benzathine NA IM: NA NA 2-8ºC


Benzylpenicillin Deep IM into upper outer
quadrant of buttock
2.4 MIU/5 ml
Children < 2 year old: IM
into midlateral muscle of
thigh

NOT for IV, intra-


arterially or subQ
administration

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Concentration
9. Benzylpenicillin NS IM: IM administration: IM: Reconstituted solution, 2-
1 MIU D5W (less stable) Deep IM into upper outer Reconstitute 1 MIU with 1.6 300 mg/ml 8ºC:
5 MIU quadrant of buttock. ml WFI: 300 mg/ml 7 days (K+ base)
Withdraw required dose IV injection: 3 days (Na+ base)
(Penicillin G 1 & 5 IV injection: without further dilution. 100 mg/ml
MIU) Over 5 minutes.
Max rate: 300 mg/min IV administration: Intermittent IV
600 mg = 1 MIU Reconstitute 1 MIU with 5.6 infusion:
Intermittent IV infusion: ml WFI/NS: 100 mg/ml 6 mg/ml
Over 30-60 minutes
IV injection:
Withdraw a required dose
without further dilution

Intermittent IV infusion:
Withdraw required dose and
further dilute with diluents.
Usually 100 ml NS

10. Caspofungin Acetate NaCl solution Intermittent IV infusion: Reconstitute 50 mg / 70 mg ≤ 0.5 mg/ml Reconstituted solution:
50 mg/70 mg Hartmann’s Over 1 hr with 10.5 ml WFI: 50 / 70 1 hrs (RT)
mg/ml
Prepared infusion:
Incompatible with Withdraw required dose and 24 hrs (RT)
Glucose solution further dilute to ≤ 0.5 mg/ml 2 days (2-8ºC)
with diluents.
Usually 250 ml NS

11. Cefepime D5W IM IM administration: IM: Reconstituted & prepared


1g NS Reconstitue 1 g with 2.4 ml 280 mg/ml infusion:
Intermittent IV infusion: WFI: 280 mg/ml. 24 hrs (RT)
Over 30 min Withdraw required dose Intermittent IV 7 days (2-8ºC)
without further dilution infusion:
1 – 40 mg/ml Color of cefepime solution
IV administration: may darken on storage.
Reconstitute 1 g with 10 ml However, product potency
WFI: 100 mg/ml. is not adversely affected.

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Concentration
Cefepime Withdraw required dose and
1g further dilute in 50 or 100 ml
diluents.
Usually 1 g in 50 ml diluents

12. Cefoperazone D5W IM IM administration: IM: Reconstituted & prepared


1g NS Reconstitute 1g with 3.4 ml 250 mg/ml infusion:
IV injection: WFI: 250 mg/ml 24 hrs (RT)
Over minimum of 3 min Withdraw required dose IV injection: 5 days (2-8ºC)
Lactate Ringers’ without further dilution 100 mg/ml
(not for Intermittent IV infusion:
reconstitution) 15 – 60 min IV administration: Intermittent IV
Reconstitute 1 g with 10 ml infusion:
2% lidocaine for IM diluents/WFI: 100 mg/ml 10 -50 mg/ml
administration only
IV injection:
Withdraw required dose
without further dilution

Intermittent IV infusion:
Withdraw required dose and
further dilute with 20 – 100
ml diluents

13. Cefoperazone 500 mg D5W IM Reconstitute 1 g with 3.4 ml IM & IV injection: Reconstituted & Prepared
+ Sulbactam 500 mg NS WFI: 250 mg/ml 250 mg/ml infusion:
IV injection: 1 day (RT)
Over a minimum of 3 min IM & IV injection: Intermittent IV
Lactate Ringers’ Withdraw required dose infusion:
(not for Intermittent IV infusion: without further dilution. ≤250 mg/ml
reconstitution) Over 15 to 60 min
Intermittent IV infusion: 250 mg =125 mg
Withdraw required dose and cefoperazone
further dilute to ≤250 mg/ml +125 mg
with diluents (20 – 100 ml) sulbactam

Dose 1 g to 20 ml.

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Concentration
14. Cefotaxime NS IM Reconstitute 1g with 4 ml IM & IV injection: Reconstituted solution:
1g D5W WFI:250 mg/ml 250 mg/ml 12 - 24 hrs (RT)
Gluc-NaCI IV injection: 7 – 10 days (2-8ºC)
Hartmann’s Over 3-5 min IM & IV injection: Intermittent IV
Withdraw required dose infusion: Prepared infusion:
Intermittent IV infusion: without further dilution 10-20 mg/ml 24 hrs (RT)
Over 15-60 min 5 days (2-8ºC)
2% lidocaine for IM Intermittent IV infusion:
injection only Withdraw required dose and Protect from light.
further dilute with 50-100 ml
diluents

15. Ceftazidime NS IM IM administration: IM: Prepared IM injection in


1g D5W Reconstitute 1 g with 3 ml 333 mg/ml WFI:
Gluc-NaCI IV injection: WFI: 333 mg/ml. For Dose ≤ 1g 3 hrs (RT)
Hartmann’s Over 3-5 min Withdraw required dose 3 days (2-8ºC)
Lactate Ringer’s without further dilution. IV injection:
Intermittent IV infusion: 100 mg/ml Prepared IV injection:
over 20-30 min IV administration: 12 hrs (RT)
Reconstitute 1 g with 10 ml Intermittent IV 3 days (2-8ºC)
WFI: 100 mg/ml infusion:
≤ 100 mg/ml Prepared infusion:
IV injection: 12 hrs (RT)
Withdraw required dose 1 day (2-8ºC)
without further dilution.

Intermittent IV infusion
Withdraw required dose and
further dilute to ≤ 100 mg/ml
with diluents.
(usually 100 ml NS)

Minimum 50 ml for 2 g
Minimum 100 ml for 3 g

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Concentration
16. Ceftriaxone D5W IM IM administration: IM: Prepared IM injection:
1g NS Reconstitute 1 g with WFI 250 or 350 mg/ml 24 hrs (RT)
Gluc-NaCI IV injection: 2.1 ml, 350 mg/ml Dose < 1g 10 days
Over 2-4 min 3.6 ml, 250 mg/ml (1% lidocaine, 2-8ºC)
Withdraw required dose IV injection:
1% lidocaine for IM IV intermittent infusion: without further dilution. 100 mg/ml
injection only Over at least 30 min Reconstitute & prepared
IV administration: Intermittent IV solution:
Must not be Reconstitute 1 g with 9.6 mL infusion: 6 hrs (RT)
administered WFI: 100 mg/ml 10-40 mg/ml 24 hrs (2-8ºC)
simultaneously
with calcium IV injection:
containing solution. Withdraw required dose
without further dilution

Intermittent IV infusion:
Withdraw required dose and
further dilute with 50-100 ml
diluents
(usually NS)

17. Cefuroxime NS IM: IM administration: IM: Reconstituted solution:


750 mg D5W Into large muscle such as Reconstitute 750 mg with 3 250 mg/ml 24 hrs (RT)
Gluc-NaCI gluteus or lateral aspect ml WFI: 250 mg/ml 2 days (2-8ºC)
Harmann’s of thigh Withdraw required dose IV injection:
Lactate Ringer’s without further dilution. 75 or 125 mg/ml Prepared infusion:
IV injection: 24 hrs (RT)
Over 3-5 min IV administration: Intermittent IV 7 days (2-8ºC)
Reconstitute 750 mg with infusion:
Intermittent IV infusion: WFI 15 -30 mg/ml
over 15-30 min 6 ml, 125 mg/ml
10 ml, 75 mg/ml

IV injection
Withdraw required dose
without further dilution.

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Concentration

Cefuroxime Intermittent IV infusion:


750 mg Withdraw required dose and
further dilute with 50-100 ml
diluents.
Dose 750 in 50 ml

18. Ciprofloxacin NA Intermittent IV infusion: NA ≤ 2 mg/ml Use opened vials


200 mg/100 ml 200 mg infuse over 30 immediately.
min
Discard any unused
solution.

19. Clindamycin D5W IM IM: IM: Prepared infusion:


Phosphate NS Withdraw required dose ≤ 600 mg in single 16 days (RT)
150 mg/ml Gluc-NaCI Intermittent IV infusion: without further dilution injection 32 days (2-8ºC)
Over at least 10-60
minutes Intermittent IV infusion: Intermittent IV Unused portion in vial
Not > 30 mg/min Withdraw required dose and infusion: should be discarded
Not >1200 mg/hr further dilute to ≤ 18 mg/ml ≤ 18 mg/ml
with diluents.
Never administer as
BOLUS

20. Cloxacillin Sodium D5W IM IM administration: IM: Reconstituted solution:


500 mg NS Reconstitute 500 mg with 125 or 250 mg/ml 24 hrs (RT)
IV injection: WFI 48 hrs (2-8ºC)
Over 3 - 4 min 2 ml, 250 mg/ml IV injection:
4 ml, 125 mg/ml 50 or 100 mg/ml Prepared infusion:
IV infusion 12 hrs (RT)
IV administration: IV infusion:
Reconstitute 500 mg with 1-2 mg/ml
WFI
5 ml, 100 mg/ml
10 ml, 50 mg/ml

IV injection:
Withdraw required dose

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Concentration

Cloxacillin Sodium without further dilution.


500 mg
IV infusion:
Reconstitute 500 mg with 5
ml WFI: 100 mg/ml.
Withdraw required dose and
further dilute with diluents.
Dose ≤ 500 mg to 250 ml
Dose >500 mg to 500 ml

21. Doripenem D5W Intermittent IV infusion: Reconstitute 500 mg with 10 5 mg/ml Reconstituted solution:
Monohydrate NS Over 1 hr ml WFI or NS: 50 mg/ml 1 hr
500 mg May infuse over 4 hrs
which allow the serum Withdraw required dose and Prepared infusion in NS:
Less stable in D5W concentration to maintain further dilute with diluents 8 hrs (RT)
above MIC Usually 100 ml NS, 24 hrs (2-8ºC)

Prepared infusion in D5W:


4 hrs (RT)
24 hrs (2-8ºC)

22. Erythromycin NS Intermittent IV infusion: Reconstitute 500 with 10 ml 1-2 mg /ml Reconstituted solution:
Lactobionate Over 20-60 min WFI: 50 mg/ml. Max: 5 mg/ml (↑ 8 hrs (RT)
500 mg Withdraw required dose and venous irritation) 14 days (2-8ºC)
Do not use D5W as Continuous IV infusion further dilute to 1 - 2 mg/ml
a diluents unless with diluents. Prepared infusion:
0.5 mL 8.4% Give more slowly in 24 hrs
NaHCO3 added per patients with risk factors At least 100 ml NS of
each 100 ml D5W or history of arrhythmias. infusion solution. Protect from light

Never administer as If phlebitis/pain occur with


direct IV injection used dilution, consider
(Fatal ventricular further dilution
arrhythmias)

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Concentration
23. Fluconazole NS Intermittent IV infusion: NA NA Infusions are single use
100 mg/50ML D5W Over 1-2 hrs only.
Hartmann’s
Ringer’s Max rate: Discard any unused
200 mg/hr (100 ml/hr) portion

24. Fusidic Acid D5W Intermittent IV infusion: Reconstitute 500 mg with 10 1-2 mg/ml Prepared infusion:
500 mg NS Over ≥ 2 hrs ml of supplied diluents: 50 24 hrs
Hartmann’s mg/ml.
NOT for IM or subQ Withdraw required dose and
administration further dilute to 1 - 2 mg/ml
with diluents
(usually 500 ml NS)

For patient < 50 kg,


required dose should be
diluted to at least 10 FOLD
in compatible diluents.

25. Gentamicin NS IM: IM & IV injection: Intermittent IV Prepared IV infusion:


80 mg/2 ml D5W Volume > 4 ml, distributed Withdraw required dose infusion: 24 hrs
Gluc-NaCl btw ≥ 2 injection site without further dilution. 1 mg/ml

IV injection: Intermittent IV infusion:


Over 3-5 min Withdraw required dose and
(↑ risk of neuromuscular further dilute with diluents.
blockage)

Intermittent IV infusion:
Over 30-60 min

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Concentration
26. Imipenem 500 mg + NS Intermittent IV infusion: Reconstitute 500 mg ≤ 5mg/ml Prepared infusion:
Cilastatin 500 mg D5W Dose ≤ 500 mg imipenem imipenem with 10 ml NS: imipenem 4 hrs (RT)
over 20-30 min 50 mg/ml 24 hrs (2-8ºC)
Incompatible with
lactate containing Dose ≥ 750 mg imipenem Withdraw required dose and
solution. over 40-60 min further dilute to ≤ 5mg/ml
with diluents.
Never administer as IV (usually 100-250 ml NS)
BOLUS

27. Linezolid NS Intermittent IV infusion: Withdraw required dose NA Once opened, use
600 mg/300 ml D5W Over 30-120 min without further dilution. immediately
Gluc-NaCI
Hartmann’s Flush line with D5%W, Discard any unused
Lactate Ringer’s NS or Lactate Ringers’ solution.
before and after
infusing linezolid

28. Meropenem NS IV injection: Reconstitute to concentration IV injection: Reconstituted solution in


500 mg D5W Over 3-5 min of 50 mg/ml 50 mg/ml WFI:
1g 500 mg with 10 ml WFI/NS 2 hrs (RT)
Intermittent IV infusion: 1 g with 20 ml WFI/NS Intermittent IV 12 hrs (2-8ºC)
over 15-30 min infusion:
IV injection: 1-20 mg/ml Reconstituted solution in
Withdraw required dose NS:
without further dilution. 2 hrs (RT)
18 hrs (2-8ºC)
Intermittent IV infusion:
Withdraw required dose and Prepared infusion:
further dilute to1-20 mg/ml In NS:
with diluents 4 hrs (RT)
Usually 50 – 200 ml NS 24 hrs (2-8ºC)

Prepared infusion
In D5W :
1 hr (RT)
4 hrs (2-8ºC)

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Concentration
29. Metronidazole NS Intermittent IV infusion: Withdraw required dose NA Once opened, use
500 mg/100 mL D5W At rate 5 ml/min over 30- without further dilution. immediately
Gluc-NaCI 60 min
Discard any unused
Incompatible with solution
D10%W &
Hartmann’s Do not refrigerate

30. Moxifloxacin NA Intermittent IV infusion: NA NA Once opened, use


400 mg/250 ml Over 60 minutes immediately

Never administer as Discard any unused


BOLUS solution

31. Piperacillin 4 g + NS IV injection: Reconstitute 4.5 g with 20 ml NA Reconstituted solution:


Tazobactam 500 mg D5W At least over 3-5 min WFI/NS. 24 hrs (RT)
2 days (2-8ºC)
Intermittent IV infusion: IV injection:
over 20-30 min Withdraw required dose Prepared infusion:
Incompatible with
without further dilution. 24 hrs (RT)
Hartmann’s
7 days (2-8ºC)
Intermittent IV infusion:
Withdraw required dose and
further dilute with diluents.
Usually 50-100 ml NS

32. Polymycin B NS IM IM: NA Reconstituted solution:


500,000 IU Procaine solution Reconstitute 500,000 IU with 3 days (2-8ºC)
Continuous IV infusion 2 ml WFI/diluents
D5W for IV infusion
only IT IV infusion:
Reconstitute and further
dilute 500,000 with 300-500
ml D5W

IT:
Reconstitute 500,000 IU with
10 ml NS

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Concentration
33. Streptomycin Sulphate NA IM: Reconstitute 1 g with WFI NA Injection should be freshly
1g upper outer quadrant of 4.2 ml, 200 mg/ml prepared and discard
the buttock or the mid- 3.2 ml, 250 mg/ml unused portion
lateral thigh (in children 1.8 ml, 400 mg/ml
use mid-lateral thigh) Protect from light
Withdraw required dose
NOT recommended for without further dilution
IV administration

34. Sulfamethoxazole 400 D5W Intermittent IV infusion: Solution must be diluted NA Prepared infusion:
mg+ Trimethoprim 80 NS over 60-90 hrs prior to administration 24 hrs, except:
mg Gluc-NaCI 6 hrs: 5 ml/125 ml
IV infusion duration NOT Withdraw required dose and 4 hrs: 5 ml/100 ml
Limited stability in > 1.5 hrs further dilute with diluents. 2 hrs: 5 ml/75 ml
NS Dilute 1 mL Bactrim to 25-30
NOT for IM mL diluents. Do not refrigerate
administration Usually 15 ml dilute to 500 ml
diluents Protect from light

Fluid restriction: Crystallization or turbidity


Add each 5 ml to 75 ml D5W may develop at any time.
& infuse ≤ 60 min Discard if occur.

35. Teicoplanin NS IM Reconstitute 200 mg with NA Reconstituted solution:


200 mg D5W entire content of solvent 24 hrs (2-8ºC)
Gluc-NaCI IV injection: provided: 200 mg/3 ml
Hartmann’s Over 3-5 minutes Prepared infusion:
IM & IV injection: 24 hrs
Intermittent IV infusion: Withdraw required dose
Over 30 minutes without further dilution

Intermittent IV infusion:
Withdraw required dose and
further dilute with diluents.
Usually 100 ml NS/ D5W

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Concentration
36. Tigecycline D5W Intermittent IV infusion: Reconstitute 50 mg with 5.3 ≤ 1 mg/ml Reconstituted solution:
50 mg NS Over 30-60 minutes ml diluents: 10 mg/ml 24 hrs (RT)
Withdraw required dose and
further dilute to ≤1 mg/ml. Prepared infusion:
Usually 100 ml diluents 45 hrs (2-8ºC)

37. Vancomycin D5W Intermittent IV infusion: Solution must be diluted Intermittent IV Prepared infusion:
500 mg NS Over at least 1 hr prior to administration infusion: 7 days (RT)
Hartmann’s ≤ 5 mg/ml 14 days (2-8ºC)
Over 2 hrs for 1g dose. Reconstitute 500 mg with 10
Max rate 10 mg/min mL WFI: 50 mg/ml Fluid restriction:
Max 10 mg/ml,
If red man syndrome Intermittent IV infusion: but ↑ risk of
appear: Withdraw required dose and infusion related
Infuse over 1.5 hrs - 2 hrs further dilute to effect
and increase the dilution 2.5 – 5 mg/ml with diluents
volume 500 mg dilutes with at least IT:
100 ml diluents 1-5 mg/ml
Continuous IV infusion:
Over 24 hrs Continuous IV infusion:
(only if intermittent Withdraw required dose and
technique is not feasible) add with sufficiently large
volume of diluents.
IT
IT:
Oral: Withdraw required dose and
Injection form may give further dilute to 1-5 mg/ml
orally if necessary with preservative free NS

Rotate infusion site Oral:


frequently to avoid Reconstitute 500 mg with 10
extravasation ml WFI: 50 mg.ml
Withdraw required dose and
NOT for IM dilute with 30 ml WFI.
administration Given via NG tube or drink.

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Abbreviations:

D5W : 5% Dextrose in Water


Gluc-NaCI : Glucose / Sodium Chloride Solution
IM : Intramuscular
IT : Intrathecal
IV : Intravenous
K+ : Potassium Powder
LT : Lactated Ringers
Na+ : Sodium Powder
NaCI : Sodium Chloride Solution
NS : Sodium Chloride 0.9%
RT : Room Temperature
SubQ : Subcutaneous
WFI : Water for Injection

References:

1. Charles F.Lacy, Lora L.Armstrong, Morton P. Goldman, Drug Information Handbook 19th Edition, Lexi-Comp, 2010-
2011.
2. Drug Insert.
3. Micromedex, Thomson Reuters.
4. Ministry of Health Virtual Library, Injectable Drug Guideline, Complete Medicines Online Subscription Services, July
2011 , cited from www.medicinescomplete.com.

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