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Formulation of a flush solution of heparin, vancomycin, and colistin for implantable access systems in oncology

Pharmacy CHU Timone

D. Braguer, PhD

Pharmacy CHU Timone

P. Guillet, MD

Oncologic unit CHU Timone

J. Delorme, PD

Pharmacy CHU Timone

G. Carles, PD

Pharmacy CHU Timone

R. Perez, MD

Laboratory of Bacteriology CHU Timone, Marseille, France

F. Duffaud, MD

Oncologic unit CHU Timone

A. Nicoara, MD

Oncologic unit CHU Timone

M. Drancourt, MD

Laboratory of Bacteriology CHU Timone, Marseille, France

R. Favre, MD

Oncologic unit CHU Timone

A. Crevat, PhD

Pharmacy CHU Timone

Introduction: Because of the increased use of im plantable access systems, the incidence of blood stream and catheter infections associated with these systems has concomitantly increased. Classically, he parin-lock flush solutions were used to prevent thrombosis; more recently, vancomycin was added to the solution to prevent infections caused by Gram- positive bacteria, particularly coagulase-negative Staphylococci. Disorders due to Gram-negative organ isms have now appeared in oncologic patients. We therefore tested the addition of colistin to heparin- vancomycin solutions. Colistin was chosen for its good activity against Gram-negative bacteria (98% susceptibility in our hospital), its good tolerance due to low systemic passage, and its low cost.

Methods: We developed formulations contain ing heparin (100 IU/mL) and various concentrations of vancomycin (10-500 µg/mL) and colistin (10-100 µg/mL) in 0.9% NaCl. Each sterile solution was tested for physical and chemical compatibility (spectropho tometry, nuclear magnetic resonance, and pH mea surements) and its antibacterial activity (against ox acillin-resistant Staphylococcus aureus, Enterococcus faecium, Klebsiella pneumoniae exhibiting broad- spectrum betalactamase (BSBL), imipenem-resistant Pseudomonas aeruginosa) for 2 months at 4°C and at room temperature.

Results: The most suitable combination of drugs is heparin (100 IU/mL), vancomycin (100 µg/mL), and colistin (100 µg/mL). This flush solution main tains activity when stored at 4°C for up to 1 month.

Conclusions: We feel that the combination of heparin, vancomycin, and colistin can be used as a flush solution for indwelling catheters.

Key Words: Flush solution • implantable access system • colistin • oncology.

Journal of Oncology Pharmacy Practice, Vol. 3, No. 1, 18-23 (1997)
DOI: 10.1177/107815529700300103


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