IP Heparin

My group is in the process of updating our peritonitis protocol. We are not sure if we should add heparin to the IP antibiotics. Our pharmacy in the hospital says it will bind with the antibiotics and render them unavailable.
I am inviting your comments on this…

I found an abstract on PubMed (www.ncbi.nlm.nih.gov/PubMed) that reports on a study of the stability of IP antibiotics with and without heparin. PubMed is a great resource for researching topics like this. I used this search string: “peritoneal dialysis” & antibiotic & heparin.

Ann Pharmacother. 1994 May;28(5):572-6.

Stability of ceftazidime and vancomycin alone and in combination in heparinized and nonheparinized peritoneal dialysis solution.

Vaughan LM, Poon CY.

College of Pharmacy, Medical University of South Carolina, Charleston 29425.

OBJECTIVE: To examine the stability of ceftazidime, vancomycin, and heparin, alone and in combination, in dialysis solution over six days at three temperatures. DESIGN: Nine 250-mL Dianeal PD-2 dextrose 1.5% bags were prepared with ceftazidime, vancomycin, and heparin alone and in combination at set concentrations of 100 micrograms/mL, 50 micrograms/mL, and 1 unit/mL, respectively. Three bags of each mixture were stored at 4, 25, and 37 degrees C. Duplicate samples for analysis were removed from each bag at the following time points: premix, 0, 12, 24, 48, 72, 96, 120, and 144 hours. MAIN OUTCOME MEASURES: Each sample was examined visually for signs of cloudiness and precipitation. Each sample was analyzed by stability-indicating HPLC assay for ceftazidime and vancomycin, with stability defined as less than 10 percent degradation of drug over time. RESULTS: No color change or precipitation was observed in any bag. Vancomycin with or without heparin was stable for 5-6 days at 4, 25, and 37 degrees C. Ceftazidime with and without heparin was stable for 6 days at 4 degrees C, 4 days at 25 degrees C, and less than 12 hours at 37 degrees C. Vancomycin plus ceftazidime with and without heparin was stable for 6 days at 4 degrees C and 25 degrees C, and 4-5 days at 37 degrees C. Ceftazidime plus vancomycin with or without heparin was stable for 6 days at 4 degrees C, 2-3 days at 25 degrees C, and 12 hours at 37 degrees C. CONCLUSIONS: Bulk preparations of ceftazidime and vancomycin, alone and in combination and with or without heparin in Dianeal PD dextrose 1.5% solution, are sufficiently stable for use up to 6 days under refrigeration or 48 hours at room temperature.

I also found a protocol for peritonitis on PD Serve website in a newsletter article at www.pdserve.com/pdserve/pdserve.nsf/Content/PDServe+Connection+Newsletter+-+Vol.+4,+No.4c,+2000.