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Antibiotic stability in solutions used for intravenous nutrition and fluid therapy.

The present study was designed to assess the stability of ampicillin, carbenicillin, clindamycin, kanamycin, cephalothin, methicillin, and penicillin in three parenteral hyperalimentation mixtures as reconstituted for delivery to the patient in the clinical setting. Stability at 4C, 25C, and 37C was tested in parenteral hyperalimentation mixtures containing either crystalline amino acids or a protein hydrolysate. In two series of experiments the stability at 4C, 25C, and 37C of ampicillin, cephalothin, and kanamycin also was assessed in Isolyte M (ISO M), Isolyte P (ISO P), Ringer9s lactate (LR), 5% dextrose in water, (D5W), 10% dextrose in water (D1OW), dextrose in normal saline (D5S), and normal saline (NS) to which hydrocortisone or heparin had been added. All antibiotics retained their effectiveness at an acceptable level in the hyperalimentation solutions at 4C. At 25C and 37C, all antibiotics except clindamycin lost activity by 24 hours. Kanamycin was least stable in these solutions and ampicillin also lost a significant degree of antimicrobial activity. Addition of heparin or hydrocortisone imparted stability to ampicillin in the seven parenteral solutions although significant loss of activity was noted at 37C in D5W, D1OW, D5S, and LR. Most solutions containing heparin or hydrocortisone and cephalothin turned yellow by 24 hours. A precipitate appeared in solutions containing heparin and kanamycin but there was minimal loss of antimicrobial activity. Kanamycin was stable in all solutions containing hydrocortisone except in D5W and D10W at 37C.