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Abstract

Literature review
A literature review of the stability of antibiotics in peritoneal dialysis fluids was
conducted. The information obtained was collated and presented in a format which
would serve as a useful working reference for hospital pharmacists. It was found that
the stability of antibiotics in peritoneal dialysis fluids had received little attention in the
literature. The review highlighted the lack of information on the stability and
compatibility of many of the antibiotics and antibiotic combinations commonly used for
the treatment of peritonitis. Despite increasing interest in intraperitoneal antifungal
chemotherapy, there was no information on the stability of antifungal agents in
peritoneal dialysis fluids.

Stability studies
A study of the stability of the antifungal agent, miconazole, in peritonealdialysis fluid
was conducted. Greater than 10% loss of the initial miconazole concentration occurred
within 4 hours when this drug was added to peritoneal dialysis fluid and stored in
polyvinyl chloride (PVC) bags at 20°C. Similar admixtures were stable for at least
3 days when stored in glass ampoules under the same conditions. These findings
indicated that the loss of miconazole observed in PVC bags was due primarily to an
interaction with the container, rather than chemical decomposition in solution.
Approximately 28% of the miconazole lost from the solution was recovered from the
plastic by methanolic extraction, representing sorption of miconazole by the PVC
container. In the clinicalsituation, the rapid loss of miconazole from peritoneal dialysis
fluid stored in PVC bags, would demand that such admixtures be prepared immediately
prior to administration. A study of the stability of both components of the antibacterial combination,
co-trimoxazole, in peritoneal dialysis fluid was conducted. Greater than 10% loss of
the initial trimethoprim concentration occurred within 3 days when admixtures of
co-trimoxazole in peritoneal dialysis fluid were stored in PVC bags at 20°C. The
concentration oftrimethoprim in similar admixtures stored in glass ampoules under the
same conditions, remained virtually unchanged for 9 days. This suggested that the loss
of trimethoprim observed in admixtures stored in PVC bags, may have been due to an
interaction with the container.
Greater than 10% loss of the initial sulphamethoxazole concentration occurred within
2 days in admixtures stored in PVC bags. Similar losses occurred in admixtures stored
in glass ampoules, suggesting that the mechanism of this loss was primarily chemical
decomposition in solution. Further evidence for this proposition, was the time
dependent increase in concentration of an unknown decomposition product in
admixtures stored in both plastic and glass containers. It was suspected that this
compound was a derivative of sulphamethoxazole, however it was demonstrated that it
was not sulphanilic acid or 5-methyl-3-isoxazolamine, which have previously been
identified as decomposition products of sulphamethoxazole under acid conditions. This study found that the shelf-life of admixtures of co-trimoxazole in peritoneal
dialysis fluid stored in PVC bags at 20°C, was limited by the stability of the
sulphamethoxazole component. The data conservatively indicated a shelf-life of
approximately 12 hours, since greater than 10% loss of the initialsulphamethoxazole
concentration had occurred in this time in one of the admixtures examined.

Item Type:	Thesis - Unspecified
Authors/Creators:	Holmes, SE
Keywords:	Peritoneal dialysis, Antibiotics
Copyright Holders:	The Author
Copyright Information:	Copyright 1990 the Author - The University is continuing to endeavour to trace the copyright owner(s) and in the meantime this item has been reproduced here in good faith. We would be pleased to hear from the copyright owner(s).
Additional Information:	Includes bibliographical references. Thesis (M.Pharm.)--University of Tasmania, 1990
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