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ANTIBIOTICS DILUTION
QUICK REFERENCE
2011
1st Edition
Introduction
To promote and ensure the quality use of antibiotics, many strategies have been implemented such as good
infection control practices, conduct of multidisciplinary antibiotic rounds, establishment of national antimicrobial guideline,
surveillance programmes, audits, continuous training and education amongst health personnel.
Nevertheless, dilution of antibiotics is an essential part to ensure that patients receive the optimum therapy. It is
important that the concentration of antibiotics’ dilution is correct to minimize the side effects. Besides, stability of the
antibiotics is essential to ensure safety, quality and efficacy of the drugs.
This Johore Antibiotics Dilution Quick Reference 2011 is produced to standardize the practice among all
pharmacists in Johore state. Our aim is to provide comprehensive information regarding antibiotics dilution. It remains the
responsibility of every pharmacists to evaluate the appropriateness of a particular opinion or therapy in the context of
actual clinical situation and with due consideration of any new developments in the fields.
The use of this manual requires knowledge based interpretation by health care professionals and is intended solely
for use by pharmacists in healthcare facilities. All information contained in this manual has been provided with the sole
intent that it be readily accessible for pharmacist’s information and as a guide for conducting dilution of drugs that may be
prescribed.
Advisor
Pn. Rosidah bt. Md.Din - Deputy Director of Health (Pharmacy) Johore
Johore Pharmaceutical Services Division
Contributors :
Steril/Non-Steril Preparation Working Committee Members, Johore Pharmaceutical Services Division.
Pn. Eyatul Mazuin Ayla bt. Mamdooh Waffa - Pharmacist U48, Hospital Sultanah Aminah, Johor Bahru
2. Amikacin D5W IM (preferred route): IM & IV injection: 0.25 – 5mg/ml Prepared infusion
250 mg/2mL NS Deep IM into upper outer Withdraw required dose 0.25 – 5 mg/ml:
500 mg/2mL Hartmann’s quadrant of buttocks. without further dilution. 24 hrs (RT)
Lactate Ringer’s 2 days (2-8ºC)
IV injection: Intermittent IV infusion:
Over 2-3 min Withdraw required dose and Unused portion in vial
further dilute to 0.25 – should be discarded
Intermittent IV infusion: 5mg/ml with diluents. (usually
Adult: over 30 – 60 min 100 ml NS) Protect from light and do
Infant: 1-2 hrs not freeze
Intermittent IV infusion:
Withdraw required dose and
further dilutes to with
diluents.
Dose 1.2 g in 100 ml NS
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Johore Antibiotics Dilution Quick Reference 2011
Intermittent IV infusion:
Withdraw required dose and
add to suitable volume of
diluents.
Dose ≤ 1g to 50 ml
Dose >1g to 100 ml
5. Ampicillin 1 g + NS IM Reconstitute 1.5 g with 3.2 IM & IV injection: Prepared IM/ IV injection:
Sulbactam Sodium D5W ml WFI: 375 mg/ml 375 mg/ml Use within 1 hr after
500 mg IV injection: preparation
Over 10-15 min IM & IV injection: 375 mg = 250 mg
0.5% or 2% Withdraw required dose ampicillin + 125 mg Prepared infusion in NS:
lidocaine Intermittent IV infusion: without further dilution. sulbactam 8 hrs (RT)
hydrochloride for Over 15 - 30 min 72 hrs (2-8ºC)
IM administration Intermittent IV infusion: Intermittent IV
only Withdraw required dose and infusion: Prepared infusion in D5W:
further dilute with 50 – 100 3 – 45 mg/ml 2 hrs (RT)
ml diluent. 4 hrs (2-8ºC)
3 mg/ml = 2 mg
ampicillin + 1 mg
sulbactam
45 mg = 30 mg
ampicillin + 15 mg
sulbactam
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Johore Antibiotics Dilution Quick Reference 2011
7. Azithromycin NS Intermittent IV infusion: Reconstitute 500 mg with 4.8 1 – 2 mg/ml Reconstituted solution:
500 mg D5W Over 3 hrs (1 mg/ml) ml WFI: 100 mg/ml 24 hrs (< 30ºC)
Lactated Ringer’s Over 1 hr (2 mg/ml)
Intermittent IV infusion: Prepared infusion 1-2
Minimum duration of 1 hr. Reconstituted solution 100 mg/ml:
mg/ml further dilute with 24 hrs (RT)
NOT for IM or IV bolus diluents to: 7 days (2-8ºC)
administration 500 ml, 1 mg/ml
250 ml, 2 mg/ml
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Johore Antibiotics Dilution Quick Reference 2011
Intermittent IV infusion:
Withdraw required dose and
further dilute with diluents.
Usually 100 ml NS
10. Caspofungin Acetate NaCl solution Intermittent IV infusion: Reconstitute 50 mg / 70 mg ≤ 0.5 mg/ml Reconstituted solution:
50 mg/70 mg Hartmann’s Over 1 hr with 10.5 ml WFI: 50 / 70 1 hrs (RT)
mg/ml
Prepared infusion:
Incompatible with Withdraw required dose and 24 hrs (RT)
Glucose solution further dilute to ≤ 0.5 mg/ml 2 days (2-8ºC)
with diluents.
Usually 250 ml NS
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Johore Antibiotics Dilution Quick Reference 2011
Intermittent IV infusion:
Withdraw required dose and
further dilute with 20 – 100
ml diluents
13. Cefoperazone 500 mg D5W IM Reconstitute 1 g with 3.4 ml IM & IV injection: Reconstituted & Prepared
+ Sulbactam 500 mg NS WFI: 250 mg/ml 250 mg/ml infusion:
IV injection: 1 day (RT)
Over a minimum of 3 min IM & IV injection: Intermittent IV
Lactate Ringers’ Withdraw required dose infusion:
(not for Intermittent IV infusion: without further dilution. ≤250 mg/ml
reconstitution) Over 15 to 60 min
Intermittent IV infusion: 250 mg =125 mg
Withdraw required dose and cefoperazone
further dilute to ≤250 mg/ml +125 mg
with diluents (20 – 100 ml) sulbactam
Dose 1 g to 20 ml.
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Johore Antibiotics Dilution Quick Reference 2011
Intermittent IV infusion
Withdraw required dose and
further dilute to ≤ 100 mg/ml
with diluents.
(usually 100 ml NS)
Minimum 50 ml for 2 g
Minimum 100 ml for 3 g
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Johore Antibiotics Dilution Quick Reference 2011
Intermittent IV infusion:
Withdraw required dose and
further dilute with 50-100 ml
diluents
(usually NS)
IV injection
Withdraw required dose
without further dilution.
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Johore Antibiotics Dilution Quick Reference 2011
IV injection:
Withdraw required dose
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Johore Antibiotics Dilution Quick Reference 2011
21. Doripenem D5W Intermittent IV infusion: Reconstitute 500 mg with 10 5 mg/ml Reconstituted solution:
Monohydrate NS Over 1 hr ml WFI or NS: 50 mg/ml 1 hr
500 mg May infuse over 4 hrs
which allow the serum Withdraw required dose and Prepared infusion in NS:
Less stable in D5W concentration to maintain further dilute with diluents 8 hrs (RT)
above MIC Usually 100 ml NS, 24 hrs (2-8ºC)
22. Erythromycin NS Intermittent IV infusion: Reconstitute 500 with 10 ml 1-2 mg /ml Reconstituted solution:
Lactobionate Over 20-60 min WFI: 50 mg/ml. Max: 5 mg/ml (↑ 8 hrs (RT)
500 mg Withdraw required dose and venous irritation) 14 days (2-8ºC)
Do not use D5W as Continuous IV infusion further dilute to 1 - 2 mg/ml
a diluents unless with diluents. Prepared infusion:
0.5 mL 8.4% Give more slowly in 24 hrs
NaHCO3 added per patients with risk factors At least 100 ml NS of
each 100 ml D5W or history of arrhythmias. infusion solution. Protect from light
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Johore Antibiotics Dilution Quick Reference 2011
24. Fusidic Acid D5W Intermittent IV infusion: Reconstitute 500 mg with 10 1-2 mg/ml Prepared infusion:
500 mg NS Over ≥ 2 hrs ml of supplied diluents: 50 24 hrs
Hartmann’s mg/ml.
NOT for IM or subQ Withdraw required dose and
administration further dilute to 1 - 2 mg/ml
with diluents
(usually 500 ml NS)
Intermittent IV infusion:
Over 30-60 min
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Johore Antibiotics Dilution Quick Reference 2011
27. Linezolid NS Intermittent IV infusion: Withdraw required dose NA Once opened, use
600 mg/300 ml D5W Over 30-120 min without further dilution. immediately
Gluc-NaCI
Hartmann’s Flush line with D5%W, Discard any unused
Lactate Ringer’s NS or Lactate Ringers’ solution.
before and after
infusing linezolid
Prepared infusion
In D5W :
1 hr (RT)
4 hrs (2-8ºC)
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Johore Antibiotics Dilution Quick Reference 2011
IT:
Reconstitute 500,000 IU with
10 ml NS
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Johore Antibiotics Dilution Quick Reference 2011
34. Sulfamethoxazole 400 D5W Intermittent IV infusion: Solution must be diluted NA Prepared infusion:
mg+ Trimethoprim 80 NS over 60-90 hrs prior to administration 24 hrs, except:
mg Gluc-NaCI 6 hrs: 5 ml/125 ml
IV infusion duration NOT Withdraw required dose and 4 hrs: 5 ml/100 ml
Limited stability in > 1.5 hrs further dilute with diluents. 2 hrs: 5 ml/75 ml
NS Dilute 1 mL Bactrim to 25-30
NOT for IM mL diluents. Do not refrigerate
administration Usually 15 ml dilute to 500 ml
diluents Protect from light
Intermittent IV infusion:
Withdraw required dose and
further dilute with diluents.
Usually 100 ml NS/ D5W
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Johore Antibiotics Dilution Quick Reference 2011
37. Vancomycin D5W Intermittent IV infusion: Solution must be diluted Intermittent IV Prepared infusion:
500 mg NS Over at least 1 hr prior to administration infusion: 7 days (RT)
Hartmann’s ≤ 5 mg/ml 14 days (2-8ºC)
Over 2 hrs for 1g dose. Reconstitute 500 mg with 10
Max rate 10 mg/min mL WFI: 50 mg/ml Fluid restriction:
Max 10 mg/ml,
If red man syndrome Intermittent IV infusion: but ↑ risk of
appear: Withdraw required dose and infusion related
Infuse over 1.5 hrs - 2 hrs further dilute to effect
and increase the dilution 2.5 – 5 mg/ml with diluents
volume 500 mg dilutes with at least IT:
100 ml diluents 1-5 mg/ml
Continuous IV infusion:
Over 24 hrs Continuous IV infusion:
(only if intermittent Withdraw required dose and
technique is not feasible) add with sufficiently large
volume of diluents.
IT
IT:
Oral: Withdraw required dose and
Injection form may give further dilute to 1-5 mg/ml
orally if necessary with preservative free NS
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Johore Antibiotics Dilution Quick Reference 2011
Abbreviations:
References:
1. Charles F.Lacy, Lora L.Armstrong, Morton P. Goldman, Drug Information Handbook 19th Edition, Lexi-Comp, 2010-
2011.
2. Drug Insert.
3. Micromedex, Thomson Reuters.
4. Ministry of Health Virtual Library, Injectable Drug Guideline, Complete Medicines Online Subscription Services, July
2011 , cited from www.medicinescomplete.com.
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