Physicochemical stability of binary admixtures of paracetamol and dexketoprofen-trometamol for patient-controlled analgesia use.

BACKGROUND: Intravenous admixtures of dexketoprofen-trometamol and paracetamol are frequently used in clinical practice due to synergism obtained administering both drugs concomitantly. Physicochemical stability of binary admixture containing both drugs is currently unknown. OBJECTIVE: To determine physicochemical stability of binary admixture containing dexketoprofen-trometamol 50 mg and paracetamol 1000 mg in a low-density polyethylene bottle at different storage conditions of light and temperature for advanced preparation. METHODS: Eight mixtures containing dexketoprofen-trometamol (Enantyum ampule 2 mL) 50 mg and paracetamol (Paracetamol B. Braun bottle 100 mL) 1000 mg were prepared and stored at: room temperature and exposed to light; room temperature and protected from light; refrigerated and exposed to light; and refrigerated and protected from light. From each mixture, aliquots were extracted at different times for 15 days. For physical compatibility, pH measure, gravimetric analysis and visual inspection were carried out. For chemical stability, concentrations of dexketoprofen-trometamol and paracetamol were simultaneously measured by high performance liquid chromatography. RESULTS: Only refrigerated mixtures showed incompatibility since white precipitation appeared at day 6, possibly due to paracetamol instability. Remaining drugs concentrations were in all cases≥90% after 15 days. CONCLUSION: Binary mixture containing paracetamol (100 mL) 1000 mg and dexketoprofen-trometamol (2 mL) 50 mg in a low-density polyethylene bottle is physicochemically stable for 5 days under refrigeration and 15 days at room temperature. By considering also microbial contamination, this mixture can be prepared in advance, 5 days stored refrigerated and 2 days stored at room temperature, being unnecessary protection from light.

[Expanded-spectrum beta-lactamase-producing strains of E. coli: origin, characteristics and incidence in Southern Alicante (Spain) in the period 1999-2003]. / Cepas de Escherichia coli productoras de betalactamasas de espectro extendido: origen, características e incidencia en el sur de la provincia de Alicante en el período 1999-2003.

INTRODUCTION: In the last years, we have verified the increasing emergence of bacteria, specially Escherichia coli, that produce expanded spectrum beta-lactamases (ESBL), enzymes which confer resistance to all cephalosporins (except cephamycins) and aztreonam. These bacteria are frequently resistant also to non-beta-lactam antibiotics, a fact which poses an important clinical problem. METHODS: Descriptive study of ESBL-producing strains of E. coli isolated in all kind of specimens in two hospitals of Southern Alicante (Spain), throughout a period of 57 months (January 1999 to September 2003), paying a close attention to their origin (outpatients or admitted patients), co-resistance to non beta-lactam antibiotics and evolution of their incidence. RESULTS: Respectively, 3% and 2.25% of E. coli strains isolated in each hospital produce ESBL (3.83% and 2.85% of strains from admitted and 2.74% and 2.1% from outpatients). 30.73% and 24.58% of strains ESBL were isolated in admitted patients. We found in both hospitals much higher percentages of co-resistance to ciprofloxacin, gentamicin and trimetoprim-sulfamethoxazole in ESBL-producing strains. CONCLUSION: The percentage of ESBL-producing E. coli is high in our environment, but it is even more noteworthy its clear trend to increase. It is very remarkable the high percentage of ESBL-producing strains isolated from outpatients. Finally, we emphasize the high percentages of co-resistance to non-beta-lactam antibiotics.

Cepas de Escherichia coli productoras de betalactamasas de espectro extendido: origen, características e incidencia en el sur de la provincia de Alicante en el período 1999-2003 / Expanded-spectrum beta-lactamase-producing strains of E. coli: origin, characteristics and incidence in Southern Alicante (Spain) in the period 1999-2003

INTRODUCCIÓN. En los últimos años observamos la aparición, cada vez más frecuente, de bacterias, y singularmente de Escherichia coli, productoras de betalactamasas de espectro extendido (BLEE), que confieren resistencia a las cefalosporinas (excepto cefamicinas) y aztreonam. Estas bacterias son frecuentemente resistentes también a antibióticos no betalactámicos, lo que plantea un importante problema clínico. MÉTODOS. Estudio descriptivo de las cepas de E. colip roductoras de BLEE aisladas en todo tipo de muestras en dos hospitales del sur de la provincia de Alicante en un período de 57 meses (de enero de 1999 a septiembre de 2003), con especial atención a su origen (intrahospitalario o extrahospitalario), a las corresistencias a antibióticosno betalactámicos y a la evolución cronológica de su incidencia. RESULTADOS. Respectivamente, 3 y 2,25% de las cepas de E. coli aisladas en cada hospital son productoras de BLEE(3,83 y 2,85% de las cepas procedentes de ingresados y 2,74 y 2,1% de las de pacientes ambulatorios). El 30,73y 24,58% de las cepas productoras de BLEE se aislaronen pacientes hospitalizados. En ambos hospitales se encontraron porcentajes de corresistencia a ciprofloxacino, gentamicina y cotrimoxazol muy superiores en cepas productoras de BLEE.CONCLUSIÓN. El porcentaje de cepas de E. coli productoras de BLEE es elevado en nuestro medio, pero es más notable su clara tendencia al incremento. Es reseñable el elevado porcentaje de cepas productoras procedentes del ámbito extrahospitalario. Por último, resaltamos los elevados índices de corresistencia a antibióticos no betalactámicos (AU)

INTRODUCTION. In the last years, we have verified the increasing emergence of bacteria, specially Escherichia coli, that produce expanded spectrum beta-lactamases (ESBL),enzymes which confer resistance to all cephalosporins(except cephamycins) and aztreonam. These bacteria are frequently resistant also to non-beta-lactam antibiotics,a fact wich poses an important clinical problem. METHODS. Descriptive study of ESBL-producing strains of E. coli isolated in all kind of specimens in two hospitals of Southern Alicante (Spain), troughout a period of 57 months (January 1999 to September 2003), paying a close attention to their origin (outpatients or admitted patients), co-resistance to non beta-lactam antibiotics and evolution of their incidence. RESULTS. Respectively, 3% and 2.25% of E. coli strains isolated in each hospital produce ESBL (3.83% and 2.85% of strains from admitted and 2.74% and 2.1% from out patients). 30.73% and 24.58% of strains ESBL were isolated in admitted patients. We found in both hospitals much higher percentages of co-resistance to ciprofloxacin, gentamicin and trimetoprim-sulfamethoxazole in ESBL-producing strains. CONCLUSION. The percentage of ESBL-producing E. coli is high in our environment, but it is even more note worthy its clear trend to increase. It is very remarkable the high percentage of ESBL-producing strains isolated from outpatients. Finally, we emphasize the high percentages of co-resistance to non-beta-lactam antibiotics (AU)