Stability and compatibility of Teicoplanin in parenteral nutrition solutions used in pediatrics

Aims: To investigate teicoplanin added to pediatric parenteral nutrition so lutions in terms of its stability, its compatibility with parenteral nutrit ion solution components, and its diffusion through an antibacterial filter material. Methods: Three binary solutions with and without teicoplanin were studied. Different solution compositions and teicoplanin concentrations we re used: A (98.3 +/- 8.2 mg/l), B (116.3 +/- 12.4 mg/l), and C (162.7 +/- 1 6.2 mg/l). Concentrations of teicoplanin and of solution components, osmola lity, and pH of each solution were measured at H0, after 24 h at room tempe rature, after 24 h at +4 degrees C followed by 24 h at room temperature, an d after 144 h at +4 degrees C followed by 24 h at room temperature (H168). Teicoplanin concentrations were also measured before and after passage of e ach solution through a 0.22 mu filter. Results: Teicoplanin concentrations remained unchanged from H0 to H168 in solutions A (99.6 +/- 8.3 mg/l), B (1 16.9 +/- 12.3 mg/l), and C (162.4 +/- 12.9 mg/l). During the H0-H168 interv al, iron and methionine were the only components that showed significant de creases, which were similar in solutions without teicoplanin [iron, -6.1% ( A), -6.8% (B), and -4.5% (C); methionine, -7.3% (A) and -8.7% (B)] and in t hose with teicoplanin [iron, -6.2% (A), -7.1% (B), and -4.0% (C, nonsignifi cant); methionine, -10.5% (A) and -10.7% (B)], indicating that they were no t dependent on the presence of teicoplanin. Teicoplanin levels after filtra tion were identical to prefiltration values in solutions A (86.4 +/- 5.0 vs 89.8 +/- 3.4 mg/l) and B (112.6 +/- 4.3 vs 115.3 +/- 9.0 mg/l) but were 10 .0% lower in solution C (161.6 +/- 3.9 vs 145.4 +/- 4.0; P < 0.001). Conclu sions: Teicoplanin can be added to pediatric parenteral nutrition solutions to treat central venous catheter-related infections due to teicoplanin-sus ceptible organisms since its concentrations and those of solution component s remain stable over time.