JAC Advance Access published online on March 13, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg179
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Department of Renal Medicine, Lister
Hospital, Stevenage, Herts SG1 4AB, UK
* Corresponding author. E-mail: dr.farrington{at}lister.enherts-tr.nhs.uk.
Received 7 December 2001
; revised 26 May 2002
; 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 ( Conclusion: These solutions now warrant clinical
trials to investigate their role in the management of catheter-related
septicaemia.
Stability and in vitro efficacy
of antibiotic-heparin lock solutions potentially useful
for treatment of central venous catheter-related sepsis
2 Quality Control Laboratory, Lister
Hospital, Stevenage, Herts SG1 4AB, UK
3 Department of Microbiology, Lister
Hospital, Stevenage, Herts SG1 4AB, UK
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.
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