Compiled by Pharmacy Department Version 3 (July 2017) Administration of Antibiotic Injections Review Date: 2 years or earlier if necessary Type of Rate in fluid restricted Antibiotic Directions Rate Fluid restricted patients administration patients Av ailable as powder f or reconstitution or Concentrate f or Solution f or Inf usion Powder f or reconstitution: Add 10mL W or NS to 250mg v ial or 20mL to 500mg v ial. (N.B. The reconstituted solution is light y ellow and slightly opalescent. Discard the solution if it becomes cloudy IV Infusion only Central line ONLY- Aciclovir or cry stals appear bef ore or during the inf usion.) At least 1 hour At least 1 hour undiluted (25mg/1mL) Both forms require further dilution: Doses up to 500mg add to 100mL NS. Doses 500mg - 1g add to 250mL NS Pref erably v ia central line or, if this is not possible, use large peripheral v ein IV Injection Giv e undiluted or dilute with 10-20mL NS or G 2-3 minutes Multiple daily Pref erably v ia central line or, if this is not possible, use large peripheral v ein dosing Dilute the required dose in 100mL NS or G Amikacin 30 to 60 minutes. Required dose to be diluted up to IV Infusion for Pref erably v ia central line or, if this is not possible, use large peripheral v ein 30 minutes. 50mL total v olume. ONCE daily dosing (N.B. Amikacin solution may darken f rom colourless to pale y ellow.) IM Injection No reconstitution or dilution required For doses of 1g or less ONLY . Pref erably v ia central line or, if this is not possible, use large peripheral v ein Reconstitute 250mg v ial with 5mL W, 500mg with 10mL W, 1g with 20mL W. 3-4 minutes IV Injection N.B. Reconstituted solutions are normally a pale straw colour; howev er, a transient pink colour or slight opalescence may appear during reconstitution. Reconstitute as f or IV injection Amoxicillin IV Infusion Add reconstituted solution to 100mL NS (P) or G ov er 30-60 minutes Pref erably v ia central line or, if this is not possible, use large peripheral v ein Do not inject more than 1 g of amoxicillin at one time in adults. IM Injection Reconstitute 250mg v ial with 1.5mL W, 500mg v ial with 2.5mL W, or 1g v ial with 2.5mL W or 1% lidocaine hy drochloride Central line ONLY Reconstitute 600mg v ial with 4 to 10 mL of W or NS, and 1200mg v ials with a minimum of 8mL W or NS Less than 1200mg ov er 3- 5 minutes Reconstitute 600mg v ial with 4mL IV Injection Contents of the v ial should be withdrawn and f urther diluted: For 1200mg and abov e maximum rate is of W or NS, and a minimum of 600mg v ial to a f inal v olume of 10mL and 1200mg v ial to a f inal v olume of 20mL 300mg/min 8mL to 1200mg v ials Benzylpenicillin Reconstitute as per IV injection then add to 100mL NS or G (Use G in patients with a history of renal f ailure Minimum f inal v olume as per IV IV Infusion 30-60 minutes 30-60 minutes and/or heart f ailure) injection IM Injection Reconstitute 600mg v ial with 1.6 to 2.0 mL of W Reconstitute 500 mg v ial with 5mL W, 1 g v ial with 10mL W, 2 g v ial with 10mL W or 3g v ial with 15mL W IV Injection 3-5 minutes (A clear, light y ellow to amber solution should be obtained af ter shaking) Reconstitute the contents of the v ial as f or IV injection IV Infusion 15 to 30 min Further dilute 1g or 2g doses with a minimum of 50mL NS or G and 75ml f or a 3g dose Ceftazidime Giv e a loading dose, f ollowed by a continuous inf usion ov er 24 hours. Continuous IV Reconstitute the contents of the v ial as f or IV injection 24 hours infusion Further dilute the dose with NS or G a minimum of 100mL f or a 4g (continuous inf usion) dose. Reconstitute 500mg v ial with 1.5mL W, 1g v ial with 3mL W. For doses greater than 1g inject in two separate Deep IM Injection sites. May be reconstituted with 0.5% or 1% Lidocaine Hy drochloride Injection to reduce pain on injection Reconstitute 250mg v ial with 2ml W, 750mg v ial with 6ml W and 1.5g v ial with 15ml W 3-5 minutes IV Injection Addition of water results in a y ellowish or a clear solution IV Infusion Reconstitute the contents of the v ial as f or IV injection then dilute dose required to 50mL or 100mL with NS or G 30 minutes Cefuroxime Reconstitute 250mg v ial with 1ml W, 750mg v ial with 3ml W, 1.5g v ial with 6ml W. Administer doses greater Deep IM Injection than 750mg in 2 sites due to v olume IV infusion with 1.5 g cef uroxime sodium constituted with 15 mL Water f or Injection may be added to metronidazole inf usion 30minutes Metronidazole (500 mg/100 mL) Ceftaroline IV infusion Reconstitute each 600mg v ial with 20 ml of W. Dilute the dose required in a minimum of 50mL NS or G 60 minutes IV injection (P) To the 1g v ial add 9.2mL of W, NS or G. Maximum concentration 10% (100mg/ml) At least 1 minute Chloramphenicol IV infusion Reconstitute as abov e then add to a minimum of 50ml G or NS 20-30 minutes IM injection Add 1.7ml W or NS to 1g v ial (absorption can be slow and erratic) 400mg ov er at least 60 minutes Ready diluted. Pref erably v ia central line or, if this is not possible, use large peripheral v ein Ciprofloxacin IV Infusion only 200mg ov er 30minutes Central line ONLY – Clarithromycin IV Infusion only Reconstitute 500mg v ial with 10ml W then add to 250ml NS or G. Administer into a large peripheral v ein 60 minutes 60 minutes 500mg/100ml Reconstitute 600mg v ial with 10ml W or 1.2g v ial with 20ml W IV Injection A transient pink colouration may dev elop during reconstitution. Reconstituted solutions are normally colourless 3-4 minutes Co-amoxiclav or a pale straw colour IV Infusion Reconstitute as per IV Injection then add 600mg to 50ml NS or 1.2g to 100ml NS 30 minutes Doses up to 480mg – add to 100ml NS or G Doses 961-3840 – add to 500ml NS or G Doses up to 3840mg – ov er 60- 1. 90 to 120 minutes Doses 481-960mg – add to 250ml NS or G Doses 3841mg and abov e – add to 1L NS or G 90minutes 1. Central line ONLY in critical Co-trimoxazole IV Infusion only care areas - undiluted 2. 60 minutes Use infusion pump. Pref erably via central line or, if this is not possible, use large peripheral v ein Doses 3841mg and abov e ov er a 2. Add each v ial to 75ml G If v isible turbidity or cry stallisation appears at any time bef ore or during an inf usion, discard the mixture minimum of 2 hours. Reconstitute 350mg v ial with 7ml NS and 500mg v ial with 10ml NS. Do not shake as this will cause f oaming of IV Injection the product. The reconstituted solution ranges in colour f rom pale y ellow to light brown. 2 minutes Daptomycin Pref erably v ia central line or, if this is not possible, use large peripheral v ein Dilute the reconstituted solution with NS (ty pical v olume 50mL) 30 minutes IV Infusion Pref erably v ia central line or, if this is not possible, use large peripheral v ein Reconstitute the contents of a 1g v ial with 10mL W or NS and add to a 50mL bag of NS Ertapenem IV Infusion only 30 minutes Reconstituted solutions of ertapenem range f rom colourless to pale y ellow Doses less than 2g: 3-4 minutes Reconstitute 250 to 500mg in 5 to 10ml W or 1g in 15 to 20ml W IV Injection 2g or more: 6-8 minutes Flucloxacillin IV Infusion Reconstitute as f or IV injection then add to 100ml NS or G 30-60 minutes IM Injection Reconstitute 250mg v ial with 1.5ml W and 500mg v ial with 2ml W IV injection for Can be given undiluted, or diluted with 10-20mL NS or G to aid slow administration. Multiple daily Pref erably v ia central line or, if this is not possible, use large peripheral v ein 3-5 minutes dosing IV Infusion for Gentamicin Dilute with 100mL NS or G ONCE daily dosing Pref erably v ia central line or, if this is not possible, use large peripheral v ein Give over 60 minutes (P) IM injection No reconstitution or dilution required 250mg ov er at least 30min Ready diluted. Use an inf usion pump 500mg ov er at least 60min Levofloxacin IV infusion Pref erably v ia central line or, if this is not possible, use large peripheral v ein 750mg ov er at least 90min Doses of up to 1g only. Dilute each 500mg v ial with 10ml W and 1g with 20ml W IV Injection Shake the reconstituted solution until clear and all the powder has dissolv ed Reconstituted solutions are clear, 5 minutes Meropenem range f rom colourless to y ellow, and are f ree of particles.