antibiotic compatibilities & storage...
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ANTIBIOTIC COMPATIBILITIES & STORAGE CONDITIONS
Name of
Antibiotic
Amikacin
Formulation IV
Storage
Store intact vials at 20°C to 25°C (68°F to 77°F).
Following admixture at concentrations of 0.25-5 mg/mL,
amikacin is stable for 24 hours at room temperature, 60
days at 4°C (39°F), or 30 days at -15°C (5°F). Previously
refrigerated or thawed frozen solutions are stable for 24
hours when stored at 25°C (77°F).
Compatibility
Stable in dextran 75 6% in NS, D5LR, D51/4NS, D5
1/3NS,
D51/2NS, D5NS, D10NS, D5W, D10W, D20W, LR, mannitol
20%, 1/4NS, 1/2NS, NS; variable stability in peritoneal
dialysis solutions.
Name of
Antibiotic
Gentamicin
Formulation IV/TOPICAL
Storage Store at controlled room temperature of 20°C to 25°C
(68°F to 77°F).
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Compatibility
Stable in dextran 40, D5W, D10W, mannitol 20%, LR,
NS; incompatible with fat emulsion 10%; variable
stability in peritoneal dialysis solution.
Name of Antibiotic AMOXICILLIN
Formulation IV/ORAL
Storage
Amoxicillin 250 mg and 500 mg capsules, and 125
mg/5 mL and 250 mg/5 mL unreconstituted
powder: Store at or below 20°C (68°F).
Amoxicillin 500 mg and 875 mg tablets, and 200 mg/5
mL and 400 mg/5mL unreconstituted powder:
Store at or below 25°C (77°F).
Reconstituted oral suspension remains stable for 14
days at room temperature or if refrigerated
(refrigeration preferred). Unit-dose antibiotic oral
syringes are stable at room temperature for at least
72 hours (Tu 1988).
Name of Antibiotic AMOXICILLIN + CLAVULANATE
Formulation IV/ORAL
Storage Powder for oral suspension: Store dry powder at or
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below 25°C (77°F). Reconstituted oral suspension
should be kept in refrigerator. Discard unused
suspension after 10 days (consult manufacturer's
labeling for specific recommendations). Unit-dose
antibiotic oral syringes are stable under
refrigeration for 24 hours (Tu 1988).
Tablet: Store at or below 25°C (77°F). Dispense in
original container.
Name of Antibiotic AMPICILLIN
Formulation IV/ORAL
Compatibility
Incompatible in D5W, D5NS, D10W, fat emulsion 10%,
hetastarch 6%, LR; variable stability (consult detailed
reference) in NS.
Storage Oral:
Capsules: Store at 20°C to 25°C (68°F to 77°F).
Oral suspension: Store dry powder at 20°C to 25°C
(68°F to 77°F). Once reconstituted, oral
suspension is stable for 14 days under
refrigeration.
IV:
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Store intact vials at 20°C to 25°C (68°F to 77°F).
Solutions for IM or direct IV should be used within
1 hour.
Stability of parenteral admixture in NS at 25°C
(77°F) is 8 hours (concentrations up to 30
mg/mL) and at 4°C (39°F) is 24 hours
(concentration of 30 mg/mL) or 48 hours
(concentrations up to 20 mg/mL). Protect from
freezing.
Name of Antibiotic
Piperacillin + Tazobactam
Formulation IV
Compatibility
Stable in D5W, NS, sterile water for injection; LR
(EDTA formulated product only); variable stability
(consult detailed reference) in peritoneal dialysis
solution.
Storage Vials: Store intact vials at 20°C to 25°C (68°F to 77°F).
Use single-dose or bulk vials immediately after
reconstitution. Discard any unused portion after 24
hours if stored at 20°C to 25°C (68°F to 77°F) or
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after 48 hours if stored at 2°C to 8°C (36°F to
46°F). Do not freeze vials after reconstitution.
Stability in IV bags has been demonstrated for up
to 24 hours at room temperature and up to 1 week
at refrigerated temperature. Stability in an
ambulatory IV infusion pump has been
demonstrated for a period of 12 hours at room
temperature.
Galaxy containers: Store at or below -20°C (-4°F). The
thawed solution is stable for 14 days at 2°C to 8°C
(36°F to 46°F) or 24 hours at 20°C to 25°C (68°F
to 77°F). Do not refreeze.
Name of Antibiotic Penicillin G
Formulation IV
Compatibility
Inactivated in acidic or alkaline solutions.
Penicillin G potassium: Stable in dextran 6% in
dextrose, dextran 6% in NS, D5LR, D51/4NS,
D51/2NS, D5NS, D5W, D10W, LR, 1/2NS, NS,
hetastarch 6%; incompatible with dextran 70 6%
in dextrose, dextran 40 10% in dextrose; variable
stability (consult detailed reference) in fat
emulsion 10%, peritoneal dialysis solutions.
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Penicillin G sodium: Stable in dextran 40 10%;
incompatible with fat emulsion 10%; variable
stability (consult detailed reference) in D5W, NS,
peritoneal dialysis solution.
Storage Penicillin G potassium powder for injection should be
stored below 86°F (30°C). Following
reconstitution, solution may be stored for up to 7
days under refrigeration. Premixed bags for
infusion should be stored in the freezer (-20°C or -
4°F); frozen bags may be thawed at room
temperature or in refrigerator. Once thawed,
solution is stable for 14 days if stored in
refrigerator or for 24 hours when stored at room
temperature. Do not refreeze once thawed.
Penicillin G sodium powder for injection should be
stored at controlled room temperature.
Reconstituted solution may be stored under
refrigeration for up to 3 days.
Name of Antibiotic PENICILLIN V
Formulation ORAL
Storage Refrigerate suspension after reconstitution; discard
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after 14 days.
Name of Antibiotic AZTREONAM
Formulation IV
Compatibility Solution for infusion: Stable in D5LR, D5
1/4NS,
D51/2NS, D5NS, D5W, D10W, mannitol 5%, mannitol
10%, LR, NS; variable stability (consult detailed
reference) in peritoneal dialysis solution.
Storage Vials: Prior to reconstitution, store at room
temperature; avoid excessive heat. After
reconstitution, solutions for infusion with a final
concentration of ≤20 mg/mL should be used within
48 hours if stored at room temperature or within 7
days if refrigerated. Solutions for infusion with a
final concentration of >20 mg/mL (if prepared with
SWFI or NS only) should also be used within 48
hours if stored at room temperature or within 7
days if refrigerated; all other solutions for infusion
with a final concentration >20 mg/mL must be
used immediately after preparation (unless
prepared with SWFI or NS).
Premixed frozen containers: Store unused container
frozen at ≤-20°C (-4°F). Frozen container can be
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thawed at room temperature of 25°C (77°F) or in a
refrigerator, 2°C to 8°C (36°F to 46°F). Thawed
solution should be used within 48 hours if stored at
room temperature or within 14 days if stored under
refrigeration. Do not freeze.
Name of Antibiotic
Meropenem
Formulation IV
Compatibility Stable in NS for 1 hour at controlled room temperature
and up to 15 hours refrigerated. Duplex container: Do
not admix with other drugs. Variable stability (consult
detailed reference) in D5LR, D51/4NS, D5NS, D5W,
D10W, LR, 1/2NS, mannitol 2.5%, mannitol 10%,
sodium bicarbonate 5%. Note: Meropenem stability
(admixed with NS at a concentration of 20 mg/mL) at
room temperature for >1 hour or under refrigeration for
>15 hours is not supported by the manufacturer. Data
exist supporting stability (admixed with NS at a
concentration of 20 mg/mL) at room temperature for ≤4
hours and under refrigeration ≤24 hours
Storage Freshly prepared solutions should be used. However,
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constituted solutions maintain satisfactory potency
under the conditions described below. Solutions should
not be frozen.
Store intact vials and unactivated Duplex containers at
20°C to 25°C (68°F to 77°F). Unactivated duplex
units with foil strip removed from the drug
chamber must be protected from light and used
within 7 days at room temperature. Once activated,
must be used within 1 hour if stored at room
temperature or within 15 hours if stored under
refrigeration. Do not freeze.
Dry powder should be stored at controlled room
temperature 20°C to 25°C (68°F to 77°F).
Reconstitution Infusion admixture (1 to 20 mg/mL): Solution is stable
when diluted in NS for 1 hour at up to 25°C (77°F) or
15 hours at up to 5°C (41°F). Solutions constituted with
dextrose injection 5% should be used immediately.
Note: Meropenem stability (admixed with NS at a
concentration of 20 mg/mL) at room temperature for >1
hour or under refrigeration for >15 hours is not
supported by the manufacturer. Data exist supporting
stability (admixed with NS at a concentration of 20
mg/mL) at room temperature for ≤4 hours and under
refrigeration ≤24 hours
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Name of Antibiotic Ertapenem
Formulation IV
Compatibility Stable in NS; per manufacturer do not mix with other
medications or use diluents containing dextrose.
Storage Prior to reconstitution, store vials at ≤25°C (77°F). The
reconstituted IM solution should be used within 1 hour
after preparation. The reconstituted IV solution may be
stored at room temperature (25°C [77°F]) and used
within 6 hours, or stored for 24 hours under
refrigeration (5°C [41°F]) and used within 4 hours after
removal from refrigeration. Do not freeze.
Name of Antibiotic CEFAZOLIN
Formulation IV
Compatibility Stable in D5W, D5LR, D5
1/4NS, D51/2NS, D5NS,
D10W,LR, NS; variable stability (consult detailed
reference) in peritoneal dialysis solutions.
Storage Store intact vials at room temperature and protect from
temperatures exceeding 40°C. Reconstituted solutions
of cefazolin are light yellow to yellow. Protection from
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light is recommended for the powder and for the
reconstituted solutions. Reconstituted solutions are
stable for 24 hours at room temperature and for 10 days
under refrigeration. Stability of parenteral admixture at
room temperature (25°C) is 48 hours. Stability of
parenteral admixture at refrigeration temperature (4°C)
is 14 days.
Name of Antibiotic CEFIXIME
Formulation ORAL
Storage Capsule, chewable tablet, tablet: Store at 20°C to 25°C
(68°F to 77°F).
Powder for suspension: Prior to reconstitution, store at
20°C to 25°C (68°F to 77°F). After reconstitution,
suspension may be stored for 14 days at room
temperature or under refrigeration.
Name of Antibiotic CEFUROXIME
Formulation IV/ORAL
Compatibility Stable in D5
1/4NS, D51/2NS, D5NS, D5W, D10W, LR,
NS.
Storage Injection: Store intact vials at 15°C to 30°C (59°F to
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86°F); protect from light. Reconstituted solution is
stable for 24 hours at room temperature and 48
hours when refrigerated. IV infusion in NS or D5W
solution is stable for 24 hours at room temperature,
7 days when refrigerated, or 26 weeks when frozen.
After freezing, thawed solution is stable for 24
hours at room temperature or 21 days when
refrigerated.
Oral suspension: Prior to reconstitution, store at 2°C to
30°C (36°F to 86°F). Reconstituted suspension is
stable for 10 days at 2°C to 8°C (36°F to 46°F).
Tablet: Store at 15°C to 30°C (59°F to 86°F).
Name of Antibiotic CEFTRIAXONE
Formulation IV
Compatibility Stable in D5W with KCl 10 mEq, D5
1/4NS with KCl 20
mEq, D51/2NS, D5W, D10W, NS, mannitol 5%, mannitol
10%, sodium bicarbonate 5%, bacteriostatic water,
sterile water for injection. Incompatible with calcium-
containing solutions (eg, LR, D5LR, D5R, Hartmann’s
solution, parenteral nutrition solutions). Variable
stability (consult detailed reference) in peritoneal
dialysis solutions.
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Storage Powder for injection: Prior to reconstitution, store at
≤25°C (≤77°F). Protect from light.
Premixed solution (manufacturer premixed): Store at -
20°C; once thawed, solutions are stable for 3 days
at 25°C (77°F) or for 21 days at 5°C (41°F). Do not
refreeze.
Name of Antibiotic CEPHALEXIN
Formulation ORAL
Storage Capsule: Store at 15°C to 30°C (59°F to 86°F).
Powder for oral suspension: Refrigerate suspension
after reconstitution; discard after 14 days.
Tablet: Store at 20°C to 25°C (68°F to 77°F).
Name of Antibiotic Ciprofloxacin
Formulation IV/ORAL
Compatibility Stable in D5
1/4NS, D51/2NS, D5W, D10W, LR, NS,
SWFI; variable stability (consult detailed reference)
in peritoneal dialysis solution.
Storage Injection:
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Premixed infusion: Store between 5°C to 25°C
(41°F to 77°F); avoid freezing. Protect from
light.
Vial: Store between 5°C to 30°C (41°F to 86°F);
avoid freezing. Protect from light. Diluted
solutions of 0.5-2 mg/mL are stable for up to
14 days refrigerated or at room temperature.
Microcapsules for oral suspension: Prior to
reconstitution, store below 25°C (77°F). Protect
from freezing. Following reconstitution, store
below 30°C (86°F) for up to 14 days. Protect from
freezing.
Tablet:
Immediate release: Store between 20°C to 25°C
(68°F to 77°F); excursions are permitted
between 15°C and 30°C (59°F and 86°F).
Extended release: Store at 25°C (77°F); excursions
are permitted between 15°C and 30°C (59°F
and 86°F).
Name of Antibiotic
Levofloxacin
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Formulation IV/ORAL
Compatibility Stable in D5LR, D5NS, D5
1/2NS with 20 mEq/L KCl,
D5W, NS, Plasma-Lyte® 56 in 5% dextrose, sodium
lactate (M/6); incompatible with mannitol 20%,
sodium bicarbonate 5%.
Storage Stable in D5LR, D5NS, D5
1/2NS with 20 mEq/L KCl,
D5W, NS, Plasma-Lyte® 56 in 5% dextrose, sodium
lactate (M/6); incompatible with mannitol 20%,
sodium bicarbonate 5%.
Name of Antibiotic OFLOXACIN
Formulation IV/ORAL
Storage Store at 25°C (77°F); excursions permitted to 15°C to
30°C (59°F to 86°F).
Name of Antibiotic Tetracycline
Formulation ORAL
Storage Store at 20°C to 25°C (68°F to 77°F); protect from
light. Use of outdated tetracyclines has caused a
Fanconi-like syndrome (nausea, vomiting, acidosis,
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proteinuria, glycosuria, aminoaciduria, polydipsia,
polyuria, hypokalemia).
Name of Antibiotic
Doxycycline
Formulation IV
Compatibility Solutions for IV infusion are stable in NS, D5W,
Ringer's injection, LR, D5LR.
Storage IV infusion: Protect from light. Stability varies based
on solution.
Name of Antibiotic Trimethoprim-sulfamethoxazole (co-trimoxazole):
Formulation IV/ORAL
Compatibility Stable in D5W, D5
1/2NS, LR, 1/2NS; variable stability
(consult detailed reference) in NS.
Storage Injection: Store at room temperature; do not refrigerate.
Less soluble in more alkaline pH. Protect from
light. Solution must be diluted prior to
administration. Following dilution, store at room
temperature; do not refrigerate. Manufacturer
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recommended dilutions and stability of parenteral
admixture at room temperature (25°C):
5 mL/125 mL D5W; stable for 6 hours.
5 mL/100 mL D5W; stable for 4 hours.
5 mL/75 mL D5W; stable for 2 hours.
Suspension, tablet: Store at controlled room
temperature of 15°C to 25°C (59°F to 77°F).
Protect from light.
Name of Antibiotic AZITHROMYCIN
Formulation
Compatibility Stable in D5W, D5LR, D5
1/4NS, D51/3NS, D5
1/2NS (with
or without 20 mEq/L KCl), Normosol®-M in D5,
Normosol®-R in D5, LR, NS, 1/2NS.
Storage Injection: Store intact vials of injection at room
temperature. Reconstituted solution is stable for 24
hours when stored below 30°C (86°F). The diluted
solution is stable for 24 hours at or below room
temperature (30°C [86°F]) and for 7 days if stored
under refrigeration (5°C [41°F]).
Suspension, immediate release: Store dry powder
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below 30°C (86°F). Store reconstituted suspension
at 5°C to 30°C (41°F to 86°F) and use within 10
days.
Suspension, extended release : Store dry powder ≤30°C
(86°F). Following reconstitution, store at 25°C
(77°F); excursions permitted to 15°C to 30°C
(59°F to 86°F); do not refrigerate or freeze. Should
be consumed within 12 hours following
reconstitution.
Tablet : Store between 15°C to 30°C (59°F to 86°F).
Name of Antibiotic Metronidazole
Formulation IV/ORAL
Compatibility Stable in D5W, LR, NS.
Storage Oral:
Extended release: Store at 25°C (77°F); excursions
are permitted between 15°C and 30°C (59°F
and 86°F).
Immediate release: Store at 15°C to 25°C (59°F to
77°F). Protect the tablets from light.
Injection: Store at 20°C to 25°C (68°F to 77°F). Protect
from light. Avoid excessive heat. Do not refrigerate. Do
not remove unit from overwrap until ready for use.
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Discard unused solution.
Name of Antibiotic LINEZOLID
Formulation IV/ORAL
Compatibility Stable in D51/2 NS, D5W, LR, NS
Storage Infusion: Store at 25°C (77°F). Protect from light and
freezing. Keep infusion bags in overwrap until
ready for use.
Oral suspension: Store at 25°C (77°F); following
reconstitution store at room temperature and use
suspension within 21 days. Protect from light.
Tablet: Store at 25°C (77°F). Protect from light and
moisture.
Name of Antibiotic VANCOMYCIN
Formulation IV
Compatibility Stable in D5NS, D5W, D10W, LR, NS; variable
stability in peritoneal dialysis solutions, TPN.
Storage Vials: Store at 20°C to 25°C (68°F to 77°F). After
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initial reconstitution with sterile water for injection,
D5W or NS, solutions are stable for 14 days if
refrigerated. After further dilution with D5W or
NS, the solution may be stored in a refrigerator for
14 days without significant loss of potency.
Solutions diluted with D5W and NS, LR, D5LR, or
Normosol-M and dextrose 5% may be stored in a
refrigerator for 96 hours.
Name of Antibiotic
Imipenem + Cilastatin
Formulation IV
Compatibility Variable stability in D5W, D5LR, D51/4NS, D5
1/2NS,
D5NS, D10W, mannitol 2.5%, mannitol 5%, mannitol
10%, NS, TPN.
Storage Imipenem/cilastatin powder for injection should be
stored at <25°C (77°F).
IV: Reconstituted IV solutions are stable for 4 hours at
room temperature and 24 hours when refrigerated.
Do not freeze.
Name of Antibiotic RIFAMPICIN
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Formulation ORAL
Compatibility Variable stability in D5W, NS.
Storage Store capsules and intact vials at 25°C (77°F);
excursions permitted to 15°C to 30°C (59°F to 86°F);
avoid excessive heat (>40°C [104°F]). Protect the intact
vials from light. Reconstituted vials are stable for 24
hours at room temperature.
Name of Antibiotic Colistin (colistimethate)
Formulation IV
Compatibility Stable in D5
1/4NS, D51/2NS, D5NS, D5W, LR, NS.
Storage Store intact vials (prior to reconstitution) at 20°C to
25°C (68°F to 77°F); excursions permitted to 15°C to
30°C (59°F to 86°F). Reconstituted vials may be
refrigerated at 2°C to 8°C (36°F to 46°F) or stored at
20°C to 25°C (68°F to 77°F) for up to 7 days. Solutions
for infusion should be freshly prepared; do not use
beyond 24 hours.
Name of Antibiotic Tigecycline
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Formulation IV
Compatibility Stable in NS, D5W, or LR.
Storage Prior to reconstitution, store at 20°C to 25°C (68°F to
77°F); excursions are permitted between 15°C and
30°C (59°F and 86°F). Reconstituted solution may be
stored at room temperature (not to exceed 25°C [77°F])
for up to 6 hours in the vial or up to 24 hours if further
diluted in a compatible IV solution. Alternatively, may
be stored refrigerated at 2°C to 8°C (36°F to 46°F) for
up to 48 hours following immediate transfer of the
reconstituted solution into NS or D5W.
Name of Antibiotic Chloramphenicol
Formulation IV/ORAL
Compatibility Stable in dextran 6% in dextrose, dextran 6% in NS,
D5LR, D51/4NS, D5
1/2NS, D5NS, D5W, D10W, fat
emulsion 10%, LR, 1/2NS, NS.
Storage Store at room temperature prior to reconstitution.
Reconstituted solutions remain stable for 30 days. Use
only clear solutions. Frozen solutions remain stable for
6 months.
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