JAC Advance Access originally published online on March 13, 2003
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Journal of Antimicrobial Chemotherapy (2003) 51, 849-855
© 2003 The British Society for Antimicrobial Chemotherapy
Stability and in vitro efficacy of antibiotic–heparin lock solutions potentially useful for treatment of central venous catheter-related sepsis
1 Department of Renal Medicine, 2 Quality Control Laboratory and 3 Department of Microbiology, Lister Hospital, Stevenage, Herts SG1 4AB, UK
Received 7 December 2001; returned 26 May 2002; revised 2 January 2003; accepted 21 January 2003
Objectives: Increasing numbers of patients for whom infection is a major risk are dependent on central venous catheters. Antibiotic–anticoagulant locks may have a role in preventing or treating catheter-related infections. The aim of this study was to determine the in vitro stability and efficacy of antibiotic–heparin lock solutions.
Methods: Candidate antibiotics (amikacin, ciprofloxacin, flucloxacillin, gentamicin, linezolid, teicoplanin) were investigated in vitro, either individually or in combination, in solution with heparin. The solutions were initially tested for visual precipitation. The efficacy of stable solutions and taurolidine was then tested in a catheter model bioassay system against microorganisms commonly encountered in catheter-related septicaemia.
Results: In general, lower concentrations of heparin (
1000 U/mL) combined with antibiotics resulted in precipitation, whereas high concentrations (3500–10 000 U/mL) were compatible with a broader range of antibiotic concentrations. The stability of each antibiotic–heparin combination required individual assessment. Bioassays identified the following promising antibiotic–anticoagulant solutions: for broad-spectrum empirical cover, a teicoplanin–ciprofloxacin–heparin solution; for directed use, flucloxacillin–heparin for methicillin-susceptible Staphylococcus aureus (MSSA), high dose teicoplanin–heparin for methicillin-resistant S. aureus (MRSA), high-dose linezolid–heparin for vancomycin-resistant enterococci (VRE) and ciprofloxacin–heparin for (susceptible) Pseudomonas aeruginosa; for prophylactic use, taurolidine.
Conclusion: These solutions now warrant clinical trials to investigate their role in the management of catheter-related septicaemia.
* Corresponding author. Tel: +44-1438-314-333 ext. 4230; Fax: +44-1438-781-174; E-mail: dr.farrington{at}lister.enherts-tr.nhs.uk
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