Optimising an Infusion Protocol Containing Cefepime to Limit Particulate Load to Newborns in a Neonatal Intensive Care Unit

Background: In neonatal intensive care units (NICUs), the simultaneous administration of drugs requires complex infusion methods. Such practices can increase the risk of drug incompatibilities resulting in the formation of a particulate load with possible clinical consequences. Methods: This paper evaluates strategies to reduce the particulate load of a protocol commonly used in NICUs with a potential medical incompatibility (vancomycin/cefepime combination). The protocol was reproduced in the laboratory and the infusion line directly connected to a dynamic particle counter to evaluate the particulate matter administered during infusion. A spectrophotometry UV assay of cefepime evaluated the impact of filters on the concentration of cefepime administered. Results: A significant difference was observed between the two infusion line configurations used in the NICU, with higher particulate load for cefepime infused via the emergency route. There was no change in particulate load in the absence of vancomycin. A filter on the emergency route significantly reduced this load without decreasing the cefepime concentration infused. Preparation of cefepime seemed to be a critical issue in the protocol as the solution initially contained a high level of particles. Conclusion: This study demonstrated the impact of a reconstitution method, drug dilution and choice of infusion line configuration on particulate load.

Automated Liquid Handling for Microplate Assays: a Simplified User Interface for the Hamilton Microlab STAR

Automated liquid handling stations such as the Hamilton Microlab range can be implemented to greatly enhance throughput of cell-based and cell-free assays. To facilitate utilisation past the comprehensive programming interface of the Hamilton Method Editor this paper presents a user interface (UI) that runs within Hamilton Venus and allows for a user to control and store programs for plate-to-plate transfers and serial dilutions in 96 well plate format. The interface allows for rapid control of aspiration and dispensing height, trituration, control of tip rack selection, and includes a tip washing program that can reduce the number of disposable tips utilised. The simple program interface allows the Hamilton Microlab to be used as a readily deployable microtitre plate handler, particularly for applications such as aliquoting cells for seeding, diluting a number of plates in medium, or transferring drug dilution arrays to multiple plates. This paper also discusses various optimisations to increase accuracy and rate of low volume liquid transfer. While complex liquid handling tasks such as high-throughput drug screening requires established core facilities, standalone liquid handlers with simplified interfaces can be utilised for smaller-scale research applications and educational purposes.

Pharmaceutical Preparations for Intradermal Drug Tests

Our department of pharmacy takes over all the medical skin tests prescribed by the allergy department. The production takes place in specific premises, with qualified and calibrated equipment, by a qualified and regularly assessed staff—in compliance with the French preparation guidelines. The whole activity is under the responsibility of a pharmacist—handlings are performed by hospital pharmacy technicians. Each new intradermal skin test demand leads to a feasibility analysis—irritating nature, dilution solvent, concentration—this information is gathered in a thesaurus. The manufacturing steps are the following: prescription validation, production sheet and label printing, preparation of the needed equipment, batch numbers and expiration date checking, handling under a vertical laminar flow hood and control after production. The preparation activity increases continuously and the thesaurus currently contents 302 rows with following information: drug, dilution and reconstitution solvent, pure solution concentration and maximum concentration to test with intradermal tests. Work would prospect in costs reduction and resources optimization. Thanks to the allergists’ confidence, the partnership between the two departments can go on. This guarantees the quality of the preparations tested on patients but also the skin tests reproducibility.

In Vitro Comparison of Terbinafine and Itraconazole against Penicillium marneffei

ABSTRACT We evaluated terbinafine and itraconazole against 30 isolates ofPenicillium marneffei using a modification of the National Committee for Clinical Laboratory Standards broth macrodilution MIC testing protocol for yeasts. The minimal fungicidal concentration (MFC) was determined by plating 100 μl from each MIC drug dilution having no growth onto Sabouraud glucose agar incubated at 30°C. The MFC was the dilution at which growth was absent at 72 h of incubation. The MICs, in micrograms per milliliter, were as follows: terbinafine, 0.03 to 1.0 (geometric mean titer, 0.09); itraconazole, 0.03 to 0.5 (geometric mean titer, 0.04). The MFCs, in micrograms per milliliter, were as follows: terbinafine, 0.03 to 8 (geometric mean titer, 2.60); itraconazole, 0.03 to 8 (geometric mean titer, 2.45). Primary fungicidal activity (MFC within 2 dilutions of MIC) was observed with terbinafine in eight isolates and with itraconazole in four isolates. The data indicate that terbinafine is active against P. marneffei in vitro and may have a previously unrealized role in the management of infections caused by this fungus.

The Theory and Practice of Retrograde Infusion: Influence of Tube Diameter on Drug Delivery

This work identifies a model for the flow dynamics of retrograde drug infusion, thereby helping to clarify the influence of variables on drug dilution in the apparatus and hence drug infusion rate. The study is a 23 factorial design that focuses on the influence of tube diameter (0.065 vs. 0.120 inches) in conjunction with changes in injected drug volume (2.0 vs. 5.0 ml) and iv flow rate (2.0 vs. 10.0 ml h−1). Each of the three variables was shown to exert a statistically significant (p = 0.01) effect on the total volume of fluid necessary to clear a dose from the retrograde apparatus. In all cases studied, smaller diameter tubes, larger injected drug volumes, and slower iv flow rates decreased the total volume fraction (F0.95). Within the confines of the study, practitioners may use an F0 95 value of 1.5 to predict the time at which a patient's retrograde drug infusion is likely to be complete. This, in turn, may be used to facilitate proper timing of blood sampling for therapeutic drug monitoring as well as other pharmacokinetic manipulations.