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

Aims: To investigate toicoplanin added to pediatric parenteral nutrition solutions in terms of its stability, its compatibility with parenteral nutrition 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 were used: A (98.3 ± 8.2 mg/l), B (118.3 ± 12.4 mg/l), and C (162.7 ± 16.2 mg/l). Concentrations of teicoplanin and of solution components, osmolality, and pH of each solution were measured at H0, after 24h at room temperature, after 24 h at +4°C followed by 24 h at room temperature, and after 144 h at +4°C followed by 24 h at room temperature (H168). Teicoplanin concentrations were also measured before and after passage of each solution through a 0.22 μ filter. Results: Teicoplanin concentrations remained unchanged from H0 to H168 in solutionsA (99.6 ± 8.3 mg/l), B (116.9 ± 12.3 mg/l), and C (162.4 + 12.9 mg/l). During the H0-H1G8 interval, iron and methionine were the only components that showed significant decreases, 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% (13)] and in those with teicoplanin [iron, −6.2% (A), −7.1% (B), and −4.0% (C, nonsignificant); methionine −10.5% (A) −10.7% (B)], indicating that they were not dependent on the presence of teicoplanin. Teicoplanin levels after filtration were identical to prefiltration values in solutions A (86.4 ± 5.0 vs 89.8 ± 5.0 vs 89.8 ± 3.4 mg/l) and B (112.6 ± 4.3 vs 115.3 ± 9.0 mg/l) but were l0.0% lower in solution C (161.6 ± 3.9 vs 145.4 ± 4.0; P< 0.001). Conclusions: Teicoplanin can be added to pediatric parenteral nutrition solutions to treat central venouscatheter-related infections due to teicoplanin-susceptible organisms since its concentrations and those of solution components remain stable over time.