IV ANTIMICROBIAL ADMINISTRATION GUIDELINE FOR ADULTS

STABILITY/
LOCAL
ACTIVE INGREDIENT; SOLVENT FOR DILUTION INCOMPATIBILITIES ¹ GENERAL ADULT MINIMUM MAXIMUM STORAGE OF PORPHYRIA
TRADENAME(S) INJECTION SITE ALLERGY PROFILE ¹ ²
STRENGTH & (CLASS) RECONSTITUTION (after reconstitution) ² DOSE* ¹ ² ⁵ INFUSION TIME INFUSION TIME ¹ ² DILUTED RISK
REACTIONS
SOLUTION ¹ ²

All IV antibiotics and High. May cause

Room temp local reactions at Contraindicated in
NS dobutamine,
Acyclovir ZOVIRAX® WFI (below 25 °C): the injection site patients with
D5W or D10W dopamine, morphine, 5-10mg/kg IV q8h
250mg Mylan-Acyclovir NS IV infusion over ≤12 hours with inflammation hypersensitivity
RL phenytoin, tramadol (May differ for each Safe
500mg Aspen-Acyclovir 250mg / 10ml 60 min Refrigerate: and phlebitis; reactions (1); crosses
D5NS HCl, blood products virus, refer to PI) associated with
(Antiviral) Acyrax 500mg / 20ml Do not refrigerate the placenta and
250mg / 50ml and protein-containing extravasation, may
prepared solution detected in breastmilk
solutions lead to ulceration

Rarely. Hypersensitivity
(skin itching, redness, rash
NS 15mg/kg/day IM or or swelling) and cross
Amikacin allergy among
AMIKACIN- D5W IV in 2 to 3 divided IV bolus over 2-3 aminoglycosides. Amikacin
50mg Ready prepared
FRESENIUS® RL doses min Room temp contains sodium
100mg solution, dilute with Admixtures are not
Safeline- D5NS or: or (below 25 °C): Low Safe metabisulphite: May cause
250mg suitable IV solution recommended allergic-type reactions
Amikacin 100 to 200ml 15-20mg/kg q24h IV infusion over 24 hours
500mg according to Rx including anaphylactic
Sulphate Do not mix with other (2, 6) 30-60 min
1g (Aminoglycoside) reactions and life-
agents Max 1.5g daily threatening asthmatic
episodes in certain
susceptible people (1)

Amoxycillin/ IgE mediated,

Clavulanic acid AUGMENTIN® Aminoglycosides, IV bolus over 3-4 Room temp Contraindicated in
1.2g IV q6h-q8h
600mg Sandoz Co- WFI NS Ciprofloxacin, min (below 25 °C): patients with
Max 4.8g/day
1.2g Amoxyclav 600mg / 10ml RL Midazolam. or 5 hours Low Safe hypersensitivity to
Cannot be given
(Penicillin/βL- Augmaxcil 1.2g / 20ml 100ml Dextrose IV infusion over Refigerate: penicillins
IM
inhibitor (Pharmacare) Sodium bicarbonate 30-40 min < 10 hours (see **Benzyl
Combination) Penicillin)

ONLY Dextrose: Infusion-related

D5W Reconstituted Toxicity: fever, chills,
50mg / 500ml: LD: 0.25-0.5mg/kg solution: use vomiting, headache
peripheral line (conc. IV (According to immediately. hypotension. Can be
should not exceed High. If
Amphotericin B type of fungal Diluted solution Use with ameliorated by slowing
FUNGIZONE® 0.1mg/ml) DO NOT administer Extended IV thrombophlebitis/
Desoxycholate WFI infection) Minimum infusion for infusion: caution, the infusion rate or
(Conventional OR with other drugs or infusion over 4-6 extravasation
50mg 10ml 50mg / 1000ml:
General adult time is 2 hours Room temp probably decreasing the daily
amphotericin B) NS, RL, D5NS hours occur - rotate
(Antifungal) central line dose: 0.7-1mg/kg (below 25 °C): 24 safe dose. Premedication
injection site
(conc.=0.05mg/ml; IV q24h. hours with antipyretics,
Concentration should Max 1.5mg/kg/day Refrigerate: antihistamines or
not exceed 0.25mg/ml) 2 days. corticosteroids can be
Protect from light helpful (1)
 STABILITY/
LOCAL
ACTIVE INGREDIENT; SOLVENT FOR DILUTION INCOMPATIBILITIES ¹ GENERAL ADULT MINIMUM MAXIMUM STORAGE OF PORPHYRIA
TRADENAME(S) INJECTION SITE ALLERGY PROFILE ¹ ²
STRENGTH & (CLASS) RECONSTITUTION (after reconstitution) ² DOSE* ¹ ² ⁵ INFUSION TIME INFUSION TIME ¹ ² DILUTED RISK
REACTIONS
SOLUTION ¹ ²

For a patient who

experiences chills, fever,
Only Dextrose: hypotension, nausea, or
Flush line with
D5W, D10W or other non-anaphylactic
Amphotericin B NS D5W before and immediate infusion-related
WFI D20W 3-5mg/kg/day High (ensure Use with
encapsulated in AMBISOME® All Electrolytes after reactions, premedicate 30
12ml Dilute to a final Max 6mg/kg/day Slow IV infusion Refigerate: dilution caution,
Liposomes (Lipid-based Most other drugs, administration to 60 min prior to drug
(4mg/ml concentration of 1-2 (in cryptococcal over 2 hours 24 hours concentration of probably administration: A
50mg amphotericin B) Caspofungin, IV infusion over
concentration) mg/ml meningitis: HIV) 0.2-2mg/ml) safe nonsteroidal (eg, ibuprofen)
(Antifungal) Doripenem 30-60 min (at
(2) ± diphenhydramine or
2.5mg/kg/hour) paracetamol with
Protect from light
diphenhydramine or
hydrocortisone.

IV solutions:
Room temp
(below 25 °C):
1-2g IV/ IM q4h-
In NS and RL:
Ampicillin Aminoglycosides, q6h or IV bolus over 3-5 Immediate IgE
WFI 6-8hours
100mg NS Erithromycin, Ampho- 50-250mg/kg/day min (125-500mg) mediated reactions
AMPICILLIN- NS In Dextrose sol: 1
250mg D5W or D10W B, caspofungin, Max 12g/day or IV infusion over 60 may cause
FRESENIUS® (250mg / 5ml) hour Low Safe
500mg RL ciprofloxacin, Co-TMX Final concentration IV bolus over 10- min anaphylaxis
Ranamp (500mg / 10ml) Solutions for IM
1g NS + Dextrose & fluconazole. for IM injection: 15 min (doses of (see **Benzyl
(1-5g / 20 to 30ml) injection should
5g (Penicillin) Sodium Bicarbonate 125 mg/ml or 250 1-2g) Penicillin)
be freshly
mg/ml
prepared and
used within 1
hour.

Histamine-related
reactions usually occur
IV infusion Refrigerate:
during the infusion,
NS Only NS or D5W. LD: 200mg IV on 100mg dose: Reconstituted
Anidulafungin Extended IV rash, urticaria,
WFI D5W Ertapenem, sodium day 1, then 100mg 1.4ml/min (over solution up to 1
100mg infusion at max flushing, pruritis,
ERAXIS® 50mg / 15ml within an hour after bicarbonate. Variable: IV q24h 90 min) and hour. Do not High No data
(Antifungal: rate of: 1.1mg/min dyspnoea, and
100mg / 30ml reconstitution Ceftriaxone (consult (according to 200mg dose: 1.4 freeze. Infusion
Echinocandin) (1.4ml/min) hypotension. Do not
50mg / 50ml detailed reference) Diagnosis) ml/min (over 180 solution: use
exceed admin rate of
min) within 24 hours
1.1 mg/min to
minimize these events

Rare serious allergic

reactions, incl.
NS angioedema and
D5W Not as IM/ IV anaphylaxis. Skin and
RL bolus injection. Room temp subcutaneous tissue
500mg IV q24h for Extended IV disorders incl urticaria,
Azithromycin ZITHROMAX® D5NS Do not administer any IV infusion only: (below 25 °C): Use with
WFI 2 days, then infusion 1mg/ml allergic reactions,
500mg Cipla- For 1mg/ml: 500mg other medication in 2mg/ml (200ml 24 hours High extreme
4.8ml consider to switch (500ml) over 3 angioedema,
(Macrolide) Azithromyzin / 500ml the same IV line also acceptable) Refrigerate: caution photosensitivity,
to oral hours
For 2mg/ml: 500mg Infused over at 7 days erythema multiforme,
/ 250ml (200ml also least 60 min Stevens-Johnson
acceptable) syndrome and toxic
epidermal necrolysis are
rare
 STABILITY/
LOCAL
ACTIVE INGREDIENT; SOLVENT FOR DILUTION INCOMPATIBILITIES ¹ GENERAL ADULT MINIMUM MAXIMUM STORAGE OF PORPHYRIA
TRADENAME(S) INJECTION SITE ALLERGY PROFILE ¹ ²
STRENGTH & (CLASS) RECONSTITUTION (after reconstitution) ² DOSE* ¹ ² ⁵ INFUSION TIME INFUSION TIME ¹ ² DILUTED RISK
REACTIONS
SOLUTION ¹ ²

NS
D5W/ D10W Acyclovir, Ampho-B, 1-2g IV or 500mg-
WFI to dissolve, Administer around-
D5NS Azithromycin, 1g IM q8-12h IV bolus over 3-5 Room temp
dilute to minumum the-clock to Use with caution in
Aztreonam AZACTAM® RL Ganciclovir, Max 8g/day min (below 25 °C):
ml with compatible promote less Probably patients with a history
1g Section 21: Mannitol 5%/ D10W Metronidazole, (different for each or within 48 hours Low ≤2%
solution variation in peak safe of hypersensitivity to
(Monobactam) Equity 1000mg / 50ml Mitomycin type of infection) IV infusion over Refrigerate:
IM: 3ml and trough serum beta-lactams
Final concentration (consult detailed Doses higher than 20-60 min (2) within 7 days
IV: 6-10ml levels
should not exceed reference) 1g: IV only, not IM
20mg/ml

**Hypersensitivity reactions
common are common (1-
10% of patients), although
BENZYL In patients serious immediate
PENICILLIN Aminoglycosides hypersensitivity reactions
Room temp receiving very
(inactivated by high 500 000u - 20MU / Can do a (e.g. anaphylaxis, angio-
FRESENIUS® (below 25 °C): high IV doses
dosages of IV 24 hours in div Slow IV infusion: continuous oedema, bronchospasm)
Benzylpenicillin Bio-pen NS 2 days (>10MU daily)
benzylpenicillin; doses, deep IM or max 500 000u infusion of total are rare (0.02 – 0.05% of
sodium (Pen G) 1MU = 600mg WFI If Dextrose is used, Refrigerate: injection sites patients) and are more
should not be IV q4-6h. /min, daily dose: half of
1MU 5MU = 3g (volume refer to dilute with NS first 7 days. should be Safe common with parental than
administered with the (20MU dosage and doses ≥2MU: daily dose over 12 oral formulations. Skin
5MU (discontinued) table in PI) RL Draw up required alternated every 2
same admin set). only as contin. IV IV infusion over hours, then the manifestations of
(Penicillin) PENICILLIN G (refer to PI) dose and discard days to prevent
Bleomycin, Potassium infusion over 24 15-30 min other half over 12 hypersensitivity are more
1MU INJ remaining super infections common. Urticarial,
acetate, Vitamin B-Co hours) hours.
Section 21: contents and erythematous or
+ Vit C morbilliform rashes,
Equity thrombophlebitis
Stevens-Johnson syndrome
and exfoliative dermatitis
may occur occasionally.

PENILENTE Allergic reactions may

L.A.® Deep IM injection Benzathine include exfoliative
only. Adults with Room temp benzylpenicillin dermatitis, skin rashes,
Benzylpenicillin (discontinued)
Strep pharyngitis: (below 25 °C): should not be interstitial nephritis and
(Benzathine Pen) Benzathine WFI Bleomycin and
1.2MU, syphilis: use within 7 days injected Not yet vasculitis. General
1.2MU penicillin 1.2MU 1.2MU / 3.5ml Not necessary Vitamin B-Co with N/A N/A
2.4MU once a (2) intravascularly classified sensitivity reactions:
2.4MU Benzetacil 2.4MU / 7ml Vitamin-C urticaria, fever, joint
month. Refrigerate: since ischaemic
(Penicillin) 2.4MU pains and eusinophilia
β-haemolytic strep 3 days reactions may
Section 21: within hours (or several
(treat for 10 days) occur.
Equity weeks)
 STABILITY/
LOCAL
ACTIVE INGREDIENT; SOLVENT FOR DILUTION INCOMPATIBILITIES ¹ GENERAL ADULT MINIMUM MAXIMUM STORAGE OF PORPHYRIA
TRADENAME(S) INJECTION SITE ALLERGY PROFILE ¹ ²
STRENGTH & (CLASS) RECONSTITUTION (after reconstitution) ² DOSE* ¹ ² ⁵ INFUSION TIME INFUSION TIME ¹ ² DILUTED RISK
REACTIONS
SOLUTION ¹ ²

Deep IM injection Contraindicated if

only. Rotate the hypersensitive to any
Diluted solution penicillin or any component
injection site. 300
N/A. Original Local: Pain at of the formulation. Fibrosis
Benzylpenicillin 000 - 600 000 U and atrophy, GI-
Ready prepared packaging to be injection site,
(Procaine Pen G) BIO-CILLIN® Do not co-administer daily in divided Likely to be disturbances: C. diff.
solution (10ml vial) Not necessary N/A N/A stored at 2°C to sterile abscess at
3MU (discontinued) with other medication doses. Adults with safe associated diarrhea (CDAD)
300 000 U/ ml 8°C. Do not injection site, and pseudomembranous
(Penicillin) endocarditis:
freeze. thrombophlebitis colitis, allergic/ sensitivity
1.2MU q6h, reactions, anaphylaxis, sore
syphilis: 2.4MU mouth/ tongue, black hairy
daily. tongue.

Possible histamine-
mediated symptoms
Room temp
Bring refrigerated NS, RL Do not use Dextrose- LD: 70mg IV on including rash, facial
Caspofungin (below 25 °C):
CANCIDAS® vial to room 200ml containing day 1, then 50mg swelling, chills,
50mg IV infusion over 24 hours High if not diluted Probably
MSD- temperature. Do not exceed final solutions, do not co- IV q24h infusion-site pruritus,
(Antifungal: 60 min Refrigerate: correctly safe
Caspofungin WFI or NS concentration of infuse with any other (According to sensation of warmth,
Echinocandin) 48 hours (diluted
10.5ml 0.5mg/ml medication diagnosis) or bronchospasm.
solution)
Anaphylaxis has been
reported.

Aminoglycosides,
500mg - 2g q6-8- Clinical
Amiodarone, Ampho-B,
Caspofungin,
12h manifestations:
Although bolus
CEFAZOLIN NS Cimetidine, Cefotaxime, Max 12g/day Deep IM or IV Room temp urticaria, angioedema,
Cefazolin indicated,
FRESENIUS® D5W or D10W Ceftriaxone (same Surgical bolus over 3-5 (below 25 °C): bronchoedema,
500mg WFI phlebitis possible
Zefkol RL syringe), Co-TMX, prophylaxis min 24 hours Use with bronchospasm,
1g NS unless adequately
Ranzol D5NS Diphenhidramine, (within 60 min or Refrigerate: caution anaphylaxis. Cross
(Cephalosporin 1st 2-10ml Dobutamine, Dopamine, diluted IV
Aspen-Cefazolin 50-100ml before incision IV infusion over Reconstituted hyper-reactivity with
gen) Levofloxacin, Lidocaine, solutions are
Mylan-Cefazolin Protect from light time): 30-60 min solution <96 hours penicillin allergy is
Naloxone, used
<120kg: 2g generally 10% (see
Pantoprazole, Phenytoin
sodium. ≥120kg: 3g **Benzyl Penicillin)

Room temp
Extended
ACC, Acyclovir, (below 25 °C):
Aminophyllin, infusion over 3
WFI 24 hours
Cefepime Aminoglycosides, hours
Auro-Cefepime D5W or D10W NS IV bolus over 3-5 *Check stability of
500mg Ampho-B, 500mg - 1g IV/IM or: IgE mediated. Skin
Cefepime- NS D5W or D10W min product in
1g Metoclopramide, and 500mg - 2g IV Bolus of 2g, and Use with and subcutaneous
Safeline IV: 500mg / 5ml, RL or Package insert Low
2g Erythromycin, q8-12h. *Continuous IV caution tissue disorders are
MAXIPIME® 1-2g / 10ml D5NS Midazolam, Propofol, IV infusion over per dilution
(Cephalosporin 4th Max 2g IV q8h infusion of total less frequent
(discontinued) IM: 500mg / 1.5ml, 50-100ml Phenytoin, Vancomycin, 30-60 min solution.
gen) daily dose (max
1g / 3ml etc. (consult detailed
6g) over 24 hours
reference) Refrigerate:
(7)
7 days
 STABILITY/
LOCAL
ACTIVE INGREDIENT; SOLVENT FOR DILUTION INCOMPATIBILITIES ¹ GENERAL ADULT MINIMUM MAXIMUM STORAGE OF PORPHYRIA
TRADENAME(S) INJECTION SITE ALLERGY PROFILE ¹ ²
STRENGTH & (CLASS) RECONSTITUTION (after reconstitution) ² DOSE* ¹ ² ⁵ INFUSION TIME INFUSION TIME ¹ ² DILUTED RISK
REACTIONS
SOLUTION ¹ ²

Klafotaxim
Azithromycin, Room temp Although bolus
Cefotaxime- IgE mediated, 10%
Cefotaxime NS fluconazole, HES in IV/IM bolus over 3- (below 25 °C): indicated,
Fresenius 2-4g IV daily in div cross-allergenicity with
500mg WFI D5W NS, pantoprazole, 5 min 12 hours phlebitis possible
Austell-; Adco-; doses q6-12h. Use with penicillin allergic
1g 0.5g / 2ml RL (consult detailed or Refrigerate: unless adequately
Aspen- IV: Max 12g/day, caution patients: use with
(Cephalosporin 3rd 1g / 4ml D5NS reference): IV infusion over 24 hours diluted IV
Cefotaxime IM: Max 2g/dose caution (see **Benzyl
gen) 50-100ml midazolam, 20-60 min (check specific solutions are
CLAFORAN® Penicillin)
vancomycin product PI) used
(discontinued)

HES in NS, IgE mediated,

pantoprazole, (consult Room temp Maculopapular rash,
Cefoxitin WFI NS IV bolus over 3-5
Adco-Cefoxitin detailed reference): 1-2g IV q4-6-8h, (below 25 °C): urticaria, fever and other
1g D5W D5W or D10W min
Aspen-Cefoxitin vancomycin. IM is very painful, 12 hours Use with allergic reactions. Cross-
2g NS RL or Low
MEFOXIN® Compatible with not recommended Refrigerate: caution sensitivity may occur in
(Cephalosporin 2nd IV: 1g / 10ml D5NS IV infusion over up to 5% of patients with
(discontinued) aminoglycosides only Max 12g/day 36 hours (diluted
generation) IM: 1g / 2ml Mannitol 30-60 min a penicillin allergy (see
when NS 200ml and infusion solution)
D5W is used. **Benzyl Penicillin)

Serious hypersensitivity
Ampho B, 600mg IV q8-12h (anaphylactic) and skin
Room temp reactions, caution in
Ceftaroline NS Caspofungin, CAP/HAP/VRE:
WFI (below 25 °C): patients with history of
600mg D5W Diazepam, 10mg/kg q8h IV infusion over Phlebitis common
ZINFORO® 400mg or 600mg / 6 hours Safe penicillin, cephalosporin,
(Cephalosporin 5th RL Dobutamine, CAP/HAP up to 14 60 min (2) or carbapenem allergy,
20ml Refrigerate:
gen) 50-250ml Labetalol, Potassium days, VRE up to especially IgE-mediated
24 hours
phosphate (2) 28 days reactions (see **Benzyl
Penicillin) (2)

Room temp
(below 25 °C):
Acetylcysteine,
24 hours
amiodarone, Ampho 1-6g per day IV in Although bolus
Ceftazidime NS *Check stability of
B, azithromycin, div doses q8-12h IV bolus over 3-5 Bolus of 2g, and indicated,
500mg FORTUM® WFI D5W or D10W product in Cephalosporin &
caspofungin, or: 100- min *Continuous IV phlebitis possible
1g Taziject 500mg / 1.5ml RL Package insert Use with Penicillin cross allergy.
dobutamine, 200mg/kg/day or infusion of total unless adequately
2g Keftaz 1g / 3ml D5NS per dilution caution IgE mediated (see
midazolam, (deep IM doses IV infusion over daily dose over 24 diluted IV
(Cephalosporin 3rd Fresenius- 2g / 10ml 50-200ml solution. **Benzyl Penicillin)
pantoprazole, ≤ 1g) 30-60 min hours (6, 7) solutions are
gen) Protect from light Refrigerate:
phenytoin, propofol, Max 8-12g daily used
48 hours
vancomycin
(reconstituted
solution)
 STABILITY/
LOCAL
ACTIVE INGREDIENT; SOLVENT FOR DILUTION INCOMPATIBILITIES ¹ GENERAL ADULT MINIMUM MAXIMUM STORAGE OF PORPHYRIA
TRADENAME(S) INJECTION SITE ALLERGY PROFILE ¹ ²
STRENGTH & (CLASS) RECONSTITUTION (after reconstitution) ² DOSE* ¹ ² ⁵ INFUSION TIME INFUSION TIME ¹ ² DILUTED RISK
REACTIONS
SOLUTION ¹ ²

WFI
NS
NS
D5W
10ml; Caution in patients
Ceftazidime and RL Diluted solution: Injection site
Protect from light. with a history of Beta-
Avibactam (CA) 50-200ml* Room temp phlebitis /
ZAVICEFTA® After reconstitution, lactam allergy due to
2g/ 0.5g Ceftazidime Uncertain / variable: IV infusion over (below 25 °C): hematoma / Not yet
(Pfizer) Section vial contents 2.5g IV q8h possible cross
(Cephalosporin/βL- concentration: 8 to vancomycin 2 hours 12 hours thrombosis; classified
21 should be sensitivity among beta-
inhibitor 40 mg/ml and Refrigerate: infusion site
transferred within lactam antimicrobial
Combination) avibactam 24 hours inflammation
30min to infusion drugs
concentration: 2 to
bag for further
10 mg/ml
dilution

WFI
Many Y-site
NS Diluted solution in Caution in patients
Ceftolozane and incompatibilities: e.g.
10ml, gently shake NS or D5W: with a history of Beta-
Tazobactam (CT) albumin, amphotericin-
ZERBAXA® to dissolve. NS 1.5g IV q8h Room temp lactam allergy due to
1.5g B, caspofungin, IV infusion over Infusion site Not yet
(MSD) Section Withdraw D5W HAP/VAP (off- (below 25 °C): possible cross
(Cephalosporin/βL- phenytoin and 1 hour reactions classified
21 appropriate volume 100ml label): 3g IV q8h 24 hours sensitivity among beta-
inhibitor propofol
from reconstituted Refrigerate: lactam antimicrobial
Combination) Uncertain / variable:
vial, add to infusion 7 days drugs
vancomycin
bag

IV solutions containing
ROCEPHIN® Calcium, Ringers
Oframax Lactate.
WFI Aminoglycosides,
Ceftriaxone Adco-Ceftriaxone NS Although bolus
NS Ampho-B, Azihromycin,
250mg Aspen- D5W or D10W IV bolus over 2-4 Room temp indicated, Cephalosporins &
IM: 250-500mg / caspofungin,
500mg Ceftriaxone D5NS 1-2g IV/ IM q12- min (below 25 °C): phlebitis possible Penicillin cross allergy.
2ml clindamycin, Use with
1g Austell- Mannitol 5% + 24h or 6 hours unless adequately IgE mediated
1g / 3.5ml diphenhydramine, caution
2g Ceftriaxone D10W dobutamine, Max 4g/day IV infusion over Refrigerate: diluted IV reactions (see
IV: 250-500mg /
(Cephalosporin 3rd Fresenius- 50-100ml fluconazole, imipenem- 30 min 24 hours solutions are **Benzyl Penicillin) (1)
5ml
gen) Ceftriaxone Protect from light cilastatin, labetalol, used
1g / 10ml
Sandoz- magnesium sulfate,
Ceftriaxone phenytoin, tobramycin,
vancomycin

Azithromycin, Room temp IgE mediated

Although bolus
Cefuroxime fluconazole, (below 25 °C): hypersensitivity
WFI NS IV bolus over 3-5 indicated,
250mg ZINACEF® midazolam, In NS & Dextrose: reactions: urticaria and
NS D5W or D10W 750mg-1.5g IM/ IV min phlebitis possible
750mg Adco-; FKSA-; pantoprazole. 24 hours Use with anaphylaxis. Use with
250mg / 2ml RL q6-8h or unless adequately
1.5g Aspen- Variable: In RL: caution caution in patients with
750mg / 6ml D5NS Max 6g/day IV infusion over diluted IV
(Cephalosporin 2nd Cefuroxime Amiodarone, 8 hours history of penicillin
1.5g / 15ml 50-100ml 30-60 min solutions are
gen) cisatracurium, Refrigerate: allergy (see **Benzyl
used
vancomycin 48 hours Penicillin)
 STABILITY/
LOCAL
ACTIVE INGREDIENT; SOLVENT FOR DILUTION INCOMPATIBILITIES ¹ GENERAL ADULT MINIMUM MAXIMUM STORAGE OF PORPHYRIA
TRADENAME(S) INJECTION SITE ALLERGY PROFILE ¹ ²
STRENGTH & (CLASS) RECONSTITUTION (after reconstitution) ² DOSE* ¹ ² ⁵ INFUSION TIME INFUSION TIME ¹ ² DILUTED RISK
REACTIONS
SOLUTION ¹ ²

Acyclovir, Hypersensitivity reactions

Aminophylline, include skin rash, urticaria,
Cefepime, Clindamycin, pruritus, photosensitivity
Amphotericin B, Heparin reactions and, rarely
200-400mg IV q8- Use required dose vasculitis, Stevens-Johnson
Ciprofloxacin CIPROBAY® solutions, Furosemide, 12h Slow IV infusion and discard Probably syndrome, and anaphylaxis.
200mg Sabax/Adco- Ready prepared MgSO4, Penicillins and High, IV infusion
Not applicable Max 400mg IV over at least 60 remaining safe, Use [US Boxed Warning]: There
400mg Ciprofloxacin solution most other antibiotics only have been reports of tendon
and other drugs (Rather q8h in the min contents. with caution
(Fluoroquinolone) Ciprogen inflammation and/or rupture
not co-administer with critically ill Use opaque line. with quinolone antibiotics,
any drug) May exacerbate muscle
*Light sensitive* *Use weakness related to
opaque line* myasthenia gravis.

Room temp
(below 25 °C): In addition to rashes and
other hypersensitivity
24 hours
NS reactions, which
Many 500mg IV q12h Slow IV infusion (Reconstituted occasionally occur in
Clarithromycin D5W
WFI Incompatibilities. (Limit to 2-5 days, over 60 min solution) High, IV infusion Use with patients receiving
500mg KLACID I.V.® RL
10ml Do not co-administer then switch to oral NOT as IM/ bolus Refrigerate: only caution macrolides, leucocytoclastic
(Macrolide) D5NS vasculitis, Henoch-
with other medication if possible) Injection 48 hours
minimum 250ml Schönlein purpura, and
(Reconstituted toxic epidermal necrolysis
solution and have been reported.
diluted product)

Draw up required
Allopurinol,
dose and discard Due to Nm-blocking activity
Azithromycin, 600mg IV/ IM q8h, in high doses, Clindamycin
Aminophyllin, Ampicillin, remaining
NS IV doses should may cause enhanced
DALACIN-C® Barbiturates, Calcium contents. effects of other Nm-blocking
D5W not exceed 1.2g
Clindamycin Clindamycin- Ready prepared gluconate, Caspofungin, Max dose of 1.2g Reconstituted in agents (potential danger for
RL Max 4,8g IV/day IV infusion only High, IV infusion
600mg Fresenius solution, dilute with Erythromycin, MgSO4, IV infusion over 60 NS or Dextrose Dangerous respiratory depression).
300-900mg / 50- in div doses may over 20-60 min only Skin reactions include
(Lincosamide) Pharma-Q suitable IV solution Pantoprazole, min Room temp
150ml Phenytoin, Tobramycin, be used in life- morbilliform rash, pruritis,
Clindamycin (below 25 °C):
1.2g / 200ml Vit B-Co. Variable threatening urticaria and erythema
16 days multiforme. GIT:
(consult detailed infections
Refrigerate: Pseudomembrane collitis.
reference): Fluconazole
32 days

IV: 500mg-3g q6h

Aminoglycosides, IM: 250mg q4-6h Room temp
WFI IgE mediated. Use
Cloxacillin CLOXACILLIN- NS Erythromycin, Max 12 g/day (below 25 °C):
D5W with caution in patients
250mg FRESENIUS® D5W or D10W Pantoprazole, Doses up to 2g IV IV bolus over 3-5 IV infusion over 40- Reconstituted
NS Low Safe with history of
500mg or Section 21: RL Polymyxin B, q4-6h in severe min 60 min solution: 24 hours
IM: 1.5ml penicillin allergy (see
(Penicillin) Equity D5NS Tetracyclines, infections, e.g Diluted infusion
IV: 10-20ml **Benzyl Penicillin)
Vancomycin endocarditis for 4- solution: 12 hours
6 weeks Refrigerate:
Reconstituted
solution: 48 hours
 STABILITY/
LOCAL
ACTIVE INGREDIENT; SOLVENT FOR DILUTION INCOMPATIBILITIES ¹ GENERAL ADULT MINIMUM MAXIMUM STORAGE OF PORPHYRIA
TRADENAME(S) INJECTION SITE ALLERGY PROFILE ¹ ²
STRENGTH & (CLASS) RECONSTITUTION (after reconstitution) ² DOSE* ¹ ² ⁵ INFUSION TIME INFUSION TIME ¹ ² DILUTED RISK
REACTIONS
SOLUTION ¹ ²
LD in IBW of
COLISTIN®
55kg: 9MU IV, LD: 100ml IV Administration by oral
Colixin D5W
>70kg: 12MU IV infusion over 60 inhalation via
Colistimethate Colimycin NS
Cefazolin, Maintenance min and nebulization has
sodium (CMS) (1MU = 80mg NS RL Refrigerate: Extreme
Erythromycin, dose: 4.5MU Maintenance Low caused
1MU CMS and = 30mg 5ml 100ml for LD, 24 hours caution
Hydroxyzine HCl (360mg) IV q12h dose: 50ml IV bronchoconstriction in
(Polymyxins) colistin base) 50ml for
or infusion over 15- adult and pediatric
Section 21: maintenance dose
3MU (240mg) IV 30 min cystic fibrosis patients
Equity or Sanofi
q8h
160/800mg (10ml)
IV q8-12h,
according to Contains sodium
D5W
Diagnosis. metabisulphite and
D10W Slow IV infusion Room temp
Co-trimoxazole Ready prepared Max: 1280/ benzyl alcohol (may
BACTRIM® RL Caspofungin, over 60-90 min (below 25 °C):
(Trimethoprim/ solution, must be 6400mg/day cause
Purbac NS fluconazole, (High doses can Use within 4 hours High, IV infusion
sulphamethoxazole) diluted with (16 ampoules) in 4 Dangerous hypersensitivity in
FKSA-; Pharma- D5NS midazolam, be administered after dilution (2) only
80/400mg suitable IV solution div. doses patients with 'sulfa
Q Co-trimoxazole 5ml amp / 100ml pantoprazole over longer Do not
(Sulphonamide) according to Rx Treatment of allergy'). Risk
or periods) refrigerate
Pneumocystis particularly high in HIV-
10ml / 200ml
pneumonia in HIV: infected individuals
treat for 14-21
days

NS 10 ml
Injected through the
centre of the rubber
stopper into the Hypersensitivity
CUBICIN vial, Reconstituted reactions are rare.
pointing the needle solution and Anaphylaxis:
toward the wall of the Do not mix or co-
4-8mg/kg IV q24h diluted infusion Low if hypersensitivity
vial. Ensure the NS infuse with any other IV infusion over
Daptomycin CUBICIN® Once a day solution. reconstituted and Probably not reactions, including
entire content is wet RL medications. 30 min (1)
500mg Drymred 500 (Dr dosing, according Room temp diluted as porphyrinog pruritis, hives,
by gently rotating the 50-100ml NB: Do not use or IV bolus over 2
(Lipopeptide) Reddy's) vial. Allow to stand to Diagnosis (below 25 °C): directed enic shortness of breath,
dextrose containing min (2)
undisturbed for 10 Max 10mg/kg/day 12 hours difficulty swallowing,
diluents
min, Gently swirl Refrigerate: truncal erythema, and
the vial contents 48 hours pulmonary
for a few minutes, eosinophilia (1)
to obtain a
completely
reconstituted solution

Room temp
(below 25 °C): Use with caution in
Extended patients with penicillin-or
WFI Diazepam, potassium In NS <12 hours
infusion over 4 other beta-lactam allergy
Doripenem NS NS phosphates, propofol. In Dextrose: <4
hours per dose (1, Likely to be because of cross-hyper-
500mg DORIBAX® 10ml D5W Variable (consult 500mg-1g IV q8h hours High
2, 7) safe reactivity. If an allergic
(Carbapenem) Gently shake to 100-200ml detailed reference): Refrigerate: reaction with doripenem
or IV infusion over
form a suspension Ampho B (2) In NS <72 hours occurs, discontinue (see
60 min
In Dextrose: <24 **Benzyl Penicillin)
hours
 STABILITY/
LOCAL
ACTIVE INGREDIENT; SOLVENT FOR DILUTION INCOMPATIBILITIES ¹ GENERAL ADULT MINIMUM MAXIMUM STORAGE OF PORPHYRIA
TRADENAME(S) INJECTION SITE ALLERGY PROFILE ¹ ²
STRENGTH & (CLASS) RECONSTITUTION (after reconstitution) ² DOSE* ¹ ² ⁵ INFUSION TIME INFUSION TIME ¹ ² DILUTED RISK
REACTIONS
SOLUTION ¹ ²

Room temp
(below 25 °C):
1g q24h IV 6 hours
Use with caution in
IV: 10ml Do not mix or co- for 3-14 days, IV infusion over Refrigerate:
patients with penicillin
WFI or NS infuse with any other or 1g q24h IM up 30 min 24h, but use
Ertapenem IV: NS 50ml and cephalosporin
INVANZ® IM: 3.2ml medications. to 7 days (2) IM: deep IM within 4 hours Probably
1g IM: no further dilution High allergy, approximately
MSD-Ertapenem 1% or 2% NB: Do not use Max 1g q12h in injection into a after removal from safe
(Carbapenem) necessary 10% cross sensitivity
Lidocaine without dextrose containing critically ill, large muscle refrigerator (IM
(see **Benzyl
adrenaline diluents depending on mass (2) solutions should
Penicillin)
Diagnosis (7) be administered
within 1 hour of
preparation)

Initial
Cefepime,
reconstituted
fluconazole, linezolid,
solution (5% stock
morphine. Variable
15-20 mg/kg/day solution in WFI) is
(consult detailed
IV stable for two
reference):
in 4 div. doses (2) weeks at
Erythromycin RL or NS Ceftazidime, heparin Doses of 1g /
or as a continuous IV infusion refrigeration High, dilute Urticaria, mild skin
lactobionate ERYTHROCIN WFI 250mg / 100ml (final erythromycin 1000ml should be
IV infusion at Max rate of temperature (1) further if phlebitis Dangerous eruptions and
1g I.V.® 20ml 500mg / 200ml diluted solution with infused over 2
Max 4 g/day 500mg/hour Final diluted occurs anaphylaxis (1)
(Macrolides) 1g / 1000ml pH of at least 5.5 hours
Replace with oral solutions in NS:
desirable for stability
Erythromycin as Room temp
of solution, mixture
soon as possible (below 25 °C):
with other
8 hours
medications may
Refrigerate:
change pH)
24 hours

LD: 400-800mg IV
(12mg/kg) on day
1, then 200-400mg Frequent: Rash,
(6mg/kg) q24h. Hepatotoxicity (raised
DIFLUCAN IV®
Some cases May extend to IV LFT: ALT, AST,
Fluconazole Fluzol IV infusion over
800mg-1g/day. infusion over 120 Low if correctly Use with alkaline phosphatase
200mg Zucan Ready prepared Most drugs (consult minimum 60 min Discard remaining
Not applicable According to min administered extreme & billirubin) Rare:
400mg Aspen-; Bio-; solution detailed reference) (Max rate: 200 contents
Diagnosis (1), (2). (Max rate: caution exfoliative skin
(Antifungal: azole) Fresenius mg/hour)
Candideamia: 10ml/min) disorders, including
Fluconazole
continue Rx until Stevens-Johnson
14 days after first syndrome
negative blood
culture
 STABILITY/
LOCAL
ACTIVE INGREDIENT; SOLVENT FOR DILUTION INCOMPATIBILITIES ¹ GENERAL ADULT MINIMUM MAXIMUM STORAGE OF PORPHYRIA
TRADENAME(S) INJECTION SITE ALLERGY PROFILE ¹ ²
STRENGTH & (CLASS) RECONSTITUTION (after reconstitution) ² DOSE* ¹ ² ⁵ INFUSION TIME INFUSION TIME ¹ ² DILUTED RISK
REACTIONS
SOLUTION ¹ ²

Despite further
Paraben preserved IV infusion ONLY.
dilution in IV
NS bacteriostatic WFI 5mg/kg IV q12h for
Discard remaining fluids, phlebitis
D5W (may cause 7-14 days, usually
contents, or and/or pain may Haematological effects
Ganciclovir RL precipitation). maintenance dose Slow IV infusion No data,
WFI Refrigerate: occur at site of IV include neutropenia
500mg CYMEVENE® 500mg / 1000ml Aztreonam, cefepime, is once a day or as over 60 min or probably
10ml use within 24 infusion, take and thrombocytopenia;
(Antiviral) (flush line with NS ondansetron, directed, longer dangerous
hours of care to administer anaemia also occurs
before and after piperacillin/tazobacta specifically
preparation only into veins
administration) m (consult detailed according to
with good blood
reference) Diagnosis
flow

Allopurinol, Ampho B,
Ampicillin, azithromycin,
D5W cholesteryl sulfate
complex, cefepime, 4-7mg/kg/day IV or Diluted solution
NS
Gentamycin GENTAMYCIN- ceftazidime, cefuroxime, IM for infusion: Injection site
Ready prepared 80mg / 50ml IV infusion over 2 Allergic reaction,
20mg FRESENIUS® cloxacillin, Co-TMX, Given once daily or Room temp reactions, pain at
solution, dilute with 160mg / 100ml* IV infusion over hours *especially anaphylaxis,
40mg Aspen-; Sandoz- furosemide, hetastarch divided in 3 equal (below 25 °C): injection site, Safe
suitable IV solution *may be diluted in in NS, indomethacin,
20-30 min in high once daily anaphylactoid
80mg Gentamycin doses, 24 hours phlebitis/thrombo
according to Rx 200ml, especially propofol. Variable dosing reactions
(Aminoglycoside) Garamycin according to Age, Refrigerate: phlebitis
high once daily (consult detailed Wt, Renal fx not recommended
dosing reference): heparin,
pantoprazole, phenytoin,
piperacillin/ tazobactam

Room temp
Allopurinol, amiodarone, 500mg dose: IV (below 25 °C):
NS Ampho B, azithromycin, 500mg (1 vial) IV infusion over 20- 4 hours
D5W or D10W Ceftriaxone, Co-TMX, q6h 30 min *Extended *Check stability of IgE mediated, Beta-
Imipenem/ Cilastatin TIENAM® NS
D5NS daptomycin, or 1g (2 vials) IV 1g dose: IV infusion over 3 product in lactam allergic
500/500mg Cilapen D5W High No data
Mannitol 5% & 10% fluconazole, lorazepam, q8h infusion over 40- hours per dose Package insert reactions range from
(Carbapenem) Imcil 10ml midazolam, milrinone,
500mg / 100ml Max 50mg/kg/day 60 min (7) per dilution rash to anaphylaxis
1g / 200ml sodium bicarbonate, up to 4g per day Slower if patient solution.
phenytoin sodium is nauseous Refrigerate:
24 hours

Serious and
Aciclovir, Amiodarone, Room temp
occasionally fatal
Azithromycin, Cefazolin, (below 25 °C):
TAVANIC® High. hypersensitivity and/or
Levofloxacin Cefoxitin, Ceftriaxone, 250-500mg IV q12- IV infusion 500mg 3 hours after
Levonic Slow IV only, Local irritation, anaphylactic reactions
500mg Ready prepared Furosemide, Heparin, 24h over at least 60 perforation of vial Use with
Levofloxacin - Not applicable 250mg over 30 pain, reddening of reported, discontinue
750mg solution Indomethacin, Insulin, or 500-750mg IV min, 750mg over Refrigerate: caution
Fresenius; - micafungin sodium, min infusion site and at first appearance of
(Fluoroquinolone) q24h 90 min Diluted solution
Winthrop Nitroglycerin, PPI's, phlebitis (1) rash, jaundice, or any
(5mg/ml) is stable
Phenytoin, Propofol. other sign of
for 14 days
hypersensitivity
 STABILITY/
LOCAL
ACTIVE INGREDIENT; SOLVENT FOR DILUTION INCOMPATIBILITIES ¹ GENERAL ADULT MINIMUM MAXIMUM STORAGE OF PORPHYRIA
TRADENAME(S) INJECTION SITE ALLERGY PROFILE ¹ ²
STRENGTH & (CLASS) RECONSTITUTION (after reconstitution) ² DOSE* ¹ ² ⁵ INFUSION TIME INFUSION TIME ¹ ² DILUTED RISK
REACTIONS
SOLUTION ¹ ²
IM: 600mg q24h, Colitis: [US Boxed
D5W, D10W
in more severe 2g (200ml) Abscess at Warning]: C. difficile -
Ready prepared D5NS
Cloxacillin, infections 600mg over 2 hours, injection site (IM); associated diarrhea
Lincomycin solution, may be RL 600mg-1g Room temp
erythromycin, q12h. 3g (300ml) induration, Not yet (CDAD) has been
600mg LINCOCIN® diluted with up to 1g / 100ml (100ml) infuse (below 25 °C):
phenytoin, sodium IV: 600mg-1g over 3 hours, irritation & pain at classified reported (1,2).
(Lincosamide) suitable IV 2g / 200ml over 1 hour 24 hours Angioneurotic oedema,
bicarbonate every 8-12hours 4g (400ml) injection site (IV)
solution. 3g / 300ml serum sickness and
Max 8g/day in over 4 hours (2)
4g / 400ml anaphylaxis (1)
divided doses

Ampho B, Ceftriaxone, Lactic acidosis,

Chlorpromazine, Myelosuppression,
Diazepam, Phenytoin, Discard any Peripheral and optic
600mg IV q12h
PPI's, Erithromycin, Co- unused solution. neuropathy, Serotonin
Linezolid ZYVOXID® CAP/HAP/VRE: syndrome (with
TMX, Cefriaxone and Extended Keep infusion Probably not
200mg Linezolid- Ready prepared 10mg/kg q8h IV infusion over at concommitant serotonergic
Not applicable MAOI's. Do not infusion over 60- bags in overwrap No data porphyrinog
600mg Fresenius solution. CAP/HAP up to 14 least 30 min drugs), Superinfusionection
administer with other 120min per dose (protected against enic (C. diff. associated
(Oxazolidinone) Linzai drugs. Flush line with days, VRE up to
light) until ready diarrhoea), NB: Adverse
D5W, NS, or RL before 28 days hematologic effects of
for use.
and after infusing linezolid include anemia and
linezolid thrombocytopenia

Room temp (below

25 °C): In
NS: 4 hours
(Meronem PI: 8
NS (preferred) hours) IgE mediated,
Aciclovir, Ampho B, *Extended In dextrose: 3
MERONEM® D5W or D10W IV bolus over 5 angioedema and
Meropenem diazepam, infusion over 3 hours
Mercide WFI RL min anaphylaxis. Use with
500mg metronidazole, 500mg - 2g IV q8h hours per dose *Check stability of Use with
Meroject 500mg / 10ml D5NS or High caution in patients with
1g ondansetron, Max 6g/day Check stability of specific product in caution
Aspen- 1g / 20ml Mannitol IV infusion over Penicillin allergy.
(Carbapenem) pantoprazole, sodium product in PI Package insert per
Meropenem 500mg / 50ml 15-30 min dilution solution. Approximately 10 %
bicarbonate (1,6,7)
1g / 50-200ml Refrigerate: cross-sensitivity
24 hours (Meroject
PI) 48
hours
(Meronem PI)

Ampho B, cholesteryl Avoid concomitant drugs

sulfate complex, that contain alcohol
aztreonam, phenytoin, LD (optional): 1g
Metronidazole (Disulfiram reaction).
FLAGYL® propofol. Variable (15mg/kg) IV, Erythematous rash, pruritus,
500mg IV infusion over Use within 24 hours,
Trichazole Ready prepared (consult detailed followed by 500mg IV infusion over 30- Low, local Use with Stevens-Johnson
(Miscellaneous: Anti- Not applicable 20 min discard unused
Sabax-; Bio- solution. reference): (7.5mg/kg) IV q6- 60 min thrombophlebitis caution syndrome, toxic epidermal
Protozoal, (Rate: 5ml/min) solution necrolysis, urticaria, fever
Metronidazole Caspofungin, 8h
Anaerobic) ceftriaxone, and anaphylaxis.
Max 4g/day Discontinue if any
meropenem,
neurological signs appear.
pantoprazole
 STABILITY/
LOCAL
ACTIVE INGREDIENT; SOLVENT FOR DILUTION INCOMPATIBILITIES ¹ GENERAL ADULT MINIMUM MAXIMUM STORAGE OF PORPHYRIA
TRADENAME(S) INJECTION SITE ALLERGY PROFILE ¹ ²
STRENGTH & (CLASS) RECONSTITUTION (after reconstitution) ² DOSE* ¹ ² ⁵ INFUSION TIME INFUSION TIME ¹ ² DILUTED RISK
REACTIONS
SOLUTION ¹ ²

NS NS or D5W Potential for

D5W ***Reconstituted anaphylactoid reactions,
(5ml taken from solution should be including shock.
100-150mg IV IV infusion over 60 More rapid infusions may
Micafungin 100ml bag) withdrawn from vial Mycamine may not be Low (2.5%
once daily, min. Recommended to result in more frequent
50mg NB: Gently swirl to and returned into co-infused with other primarily in HIV
according to Administer use infusion histamine mediated
100mg MYCAMINE® dissolve the 100ml dilution medicinal products infected patients Safe
Patient's body concentrations solution reactions. Monitor
(Antifungal: powder; every solution. except reconstituted with peripheral carefully in patients with
weight and >1.5mg/ml via immediately
Echinocandin) effort should be Flush line with NS solutions lines) severe liver function
Diagnosis, see PI central catheter
made to minimise prior to impairment OR receiving
te amount of foam, administration. concomitant hepatotoxic
DO NOT SHAKE Protect from light therapy.

Severe hypersensitivity
reactions, including
anaphylaxis, have occurred,
Prompt discontinuation of
Room temp drug should occur if skin
Moxifloxacin AVELON IV® Pantoprazole, 400mg IV q24h (below 25 °C): rash or other signs of
Ready prepared IV infusion over
400mg Austell- Not applicable sodium bicarbonate, (once daily for ALL 24 hours High No data hypersensitivity arise.
solution 60 min Pseudomembranous colitis
(Fluoroquinolone) Moxifloxacin vancomycin. indications) Refrigerate:
(C. diff. associated
not recommended diarrhoea). Not
recommended in patients
with severe hepatic
insufficiency.

Bolus of 4.5g,
Acyclovir, amiodarone, followed by
LD of 4.5g IV, then Room temp (below
ampho B, azithromycin, *Continuous IgE mediated. Serious
4.5g q6-8h 25 °C):
Piperacillin/ blood products, Infusion of total hypersensitivity
Immune most are stable for
tazobactam TAZOBAX® NS caspofungin, daily dose over 24 reactions, including
WFI Compromised/ 24 hours No data /
chlorpromazine,
4g/0.5g Tazocin 4 EF D5W IV infusion over at hours (applies to *Check stability of anaphylaxis, have
NS dobutamine, droperidel, Neutropenic pts: High probably
(Combination Curitaz RL least 30 min Tazocin 4 EF, specific product in been reported. More
20ml ganciclovir, haloperidol, q6h in safe
Penicillin/βL- Razobin 50-100ml hydroxyzine, mitomycin, Tazobax & Curitaz) Package insert per prone in patients with
combination with dilution solution.
inhibitor) gentamicin, vancomycin (6, 7) or: a history of penicillin
aminoglycoside Refrigerate:
(consult detailed Extended infusion allergies.
Max 18g/day 48 hours
reference) of each dose over
3-4 hours (2)

LD of 20 000-25
IM (not routinely Amphotericin B, 000 IU /kg IV
cefoxitin, cefuroxime, Total daily dose Reconstitued vials
POLYMYXIN B® recommended due followed by 12 500- Severe pain at IM Nephrotoxic or
Polymyxin B 500 D5W diazepam, heparin, can be given as are stable at 2-8 °C;
(10 000 units = to pain at inj. Site): 15 000 IU /kg IV IV infusion over injection site and Probably neurotoxic reactions.
000 IU (50mg) IV: 500 000 IU / insulin, pantoprazole, *Continuous discard unused
1mg) 500 000 IU / 2ml q12h 60-90 minutes (8) thrombophlebitis safe Other: drug fever,
(Polymyxins) 200ml - 500ml phenytoin, pip-taz, infusion over 24 solution after 24
Section 21: BGM NS or 1% procaine sulfamethoxazole/ Max total daily hours. at IV injection site urticarial rash.
hours (8)
HCl trimethoprim dose 25 000 IU
(2.5mg) /kg
 STABILITY/
LOCAL
ACTIVE INGREDIENT; SOLVENT FOR DILUTION INCOMPATIBILITIES ¹ GENERAL ADULT MINIMUM MAXIMUM STORAGE OF PORPHYRIA
TRADENAME(S) INJECTION SITE ALLERGY PROFILE ¹ ²
STRENGTH & (CLASS) RECONSTITUTION (after reconstitution) ² DOSE* ¹ ² ⁵ INFUSION TIME INFUSION TIME ¹ ² DILUTED RISK
REACTIONS
SOLUTION ¹ ²

Anaphylaxis, which
According to
Reconstituted may include
Diagnosis,
vials are stable at angioedema, urticaria,
Rifampicin RIMACTANE® TB: 8-10mg/kg IV infusion over Infusion site must
WFI for initial TPN formulas Room temp Use with bronchospasm, and
300mg Eremfat D5W <50kg: 450mg 30 min IV infusion over 3 be monitored to
dilution (no (consult detailed (below 25 °C): extreme shock. Flu-like
600mg Section 21: 300mg / 250ml q24h, Do not administer hours prevent
preservatives) reference) 24 hours caution symptoms usually
(Tuberculostatics) Equity >50 kg: 600mg IM or SC extravasation
Diluted in D5W: begin within 1-4 hours
q24h
4 hours of administration, rash,
Max 600mg/day
Impaired renal function

Should ONLY be Allergic and

administered IM, anaphylactic reactions
Ampho B, ampicillin, 14-20mg/kg/day or Use immediately should be treated in
Streptomycin heparin, 1-1.5g per day, after withdrawal the usual way with
1g noradrenaline, divided doses q8- from the multidose antihistamines,
Ready prepared Probably
5g BIO-STREP® Not applicable phenobarbital, 12h vial. IM injection adrenaline, cortisone,
solution safe
(Aminoglycosides: phenytoin, sodium (Very specific Store in a cool aminophyllin etc.
Tuberculostatics) bicarbonate dosing according dark place, below Headache, nausea,
to patient's weight 25°C vertigo ataxia &
and Diagnosis, tinnitus. Renal- and
refer to PI) (1) Ototoxicity

According to
severity of
infection. Adults:
Teicoplanin is
LD 12mg/kg
associated with a
Conflicting reports: followed by 6mg/kg
Teicoplanin TARGOCID® NS much lower incidence
WFI or solvent Amikacin, q12h for 3-4 IM/ IV bolus or IV Use with
200mg Teicowin D5W Refrigerate: of nonimmunologic
given with vial. Ciprofloxacin, doses, then 400mg infusion over 30 High extreme
400mg Tarbact RL 24 hours anaphylaxis (histamine-
Do not shake vial Gentamycin, Heparin, daily (some min caution
(Glycopeptide) Spec-Teicoplanin 50ml release) reactions in
Linezolid references state
comparison to
800mg q12h for
vancomycin
the first 3 doses)
Max 12
mg/kg/dose (6)
 STABILITY/
LOCAL
ACTIVE INGREDIENT; SOLVENT FOR DILUTION INCOMPATIBILITIES ¹ GENERAL ADULT MINIMUM MAXIMUM STORAGE OF PORPHYRIA
TRADENAME(S) INJECTION SITE ALLERGY PROFILE ¹ ²
STRENGTH & (CLASS) RECONSTITUTION (after reconstitution) ² DOSE* ¹ ² ⁵ INFUSION TIME INFUSION TIME ¹ ² DILUTED RISK
REACTIONS
SOLUTION ¹ ²

Room temp
(below 25 °C): 24
Related to
hours (up to 6
Tetracycline allergy
LD: 200mg IV, hours in the vial
profiles.
followed by 100mg and the remaining
Tigecycline NS or D5W or RL NS Bilirubinaemia,
Ampho B, diazepam, q12h IV time in the IV
50mg 50mg / 5.3ml D5W IV infusion over elevated ALT & AST
TYGACIL® esomeprazole, In severe hepatic bag). Mixed with High No data
(Tetracyclines: (10mg/ml RL 30-60 min and amilyse,
omeprazole impairment: LD NS/ D5W,
Glycylcyclines) concentration) 100ml anaphylaxis reactions,
100mg, then 25mg Refrigerate:
pseudomembrane
q12h (2) 48 hours following
colitis (C. diff .
immediate
associated diarrhoea).
transfer to dilution
solution

3mg/kg/day IM or
Hypersensitivity
IV given once
Allopurinol, ampho B, reactions and
daily or q6-8h
azithromycin, heparin, pseudomembrane
Max 5mg/kg/day
NS hetastarch in NS, IV infusion over 30- colitis may occur.
Tobramycin Ready prepared In chronic
TOBRAMYCIN- D5W & D10W indomethacin, 60 min Contains sodium
20mg solution, dilute with pulmonary Discard remaining Local: Pain at
FRESENIUS® Mannitol pantoprazole, Flush with saline Safe metabisulphate - may
80mg suitable IV solution colonisation of contents injection site
Nebcin RL piperacillin/tazobacta before and after cause hypersensitivity
(Aminoglycoside) according to Rx P. aeruginosa in
50-100ml m, propofol. Variable administration in susceptible
CF: Inhalation of
(consult detailed individuals that are
300mg over 15
reference): Heparin. allergic to sulfite
min q12h for 28
preservatives.
days (2)

Any dose >500

mg: IV intermittent "Red-man syndrome":
Albumin, ampho B,
infusion over at more than 50% of
cephalosporins, Based on actual
least 60 min. patients experience
ciprofloxacin, body weight: 15-20 Room temp immediate cutaneous
If "Red-man-
D5W cloxacillin, mg/kg/dose q12h (below 25 °C): 24 erythema, flushing, and
ASPEN- Slow IV infusion syndrome" occurs,
Vancomycin NS furosemide, Severely ill: LD hours pruritis, which is the
VANCOMYCIN® WFI ONLY: increase infusion
500mg RL imipenem, idarubicin, 30mg/kg to rapidly Refrigerate: result of non-IgE-
Vancocin-Sandoz 500mg / 10ml 500mg over 30 time to 1.5-2 High Safe
1g Dextrose + RL moxifloxacin, achieve target 24 hours mediated histamine
Mylan- 1g / 20ml min hours and release. NB: Can be
(Glycopeptide) 500mg / 100ml phenytoin, piperacillin- concentrations. *Check stability of
Vancomycin (max 1g/hour) increase the prevented by slowing the
1g / 200ml tazobactam, For C. diff .: oral specific product in
dilution volume. rate of infusion and
valproate. Variable 500mg-2g daily in Package insert
or Total daily premedicating with
(consult detailed divided doses q6h
dose as histamine-1 receptor
reference) antihistamines
Continuous
infusion (6)
 STABILITY/
LOCAL
ACTIVE INGREDIENT; SOLVENT FOR DILUTION INCOMPATIBILITIES ¹ GENERAL ADULT MINIMUM MAXIMUM STORAGE OF PORPHYRIA
TRADENAME(S) INJECTION SITE ALLERGY PROFILE ¹ ²
STRENGTH & (CLASS) RECONSTITUTION (after reconstitution) ² DOSE* ¹ ² ⁵ INFUSION TIME INFUSION TIME ¹ ² DILUTED RISK
REACTIONS
SOLUTION ¹ ²

Caution if history of
Cephalosporins hypersensitivity against
(Ceftriaxone), other azoles. During IV
LD: 6 mg/kg IV
NS Nitroprusside, 4.2% infusion, anaphylactoid-type
q12h for 2 doses, reactions, including flushing,
D5W Sodium bicarbonate
Voriconazole maintain after 24 Rate not to fever, sweating,
WFI D5NS IV Solution, Blood IV infusion over 1- Refrigerate: No data -
200mg VFEND® hours with: exceed High tachycardia, chest
19ml RL products, Electrolyte 2 hours 24 hours avoid tightness, dyspnoea,
(Antifungal: Triazole) 3-4mg/kg q12h 3mg/kg/hour
D5W + KCl 20mEq solutions, faintness, nausea, pruritus,
According to
50-100ml Pantoprazole, and rash have occurred.
Diagnosis Elevated ALT & AST,
Phenytoin,
bilirubin. Hypokalaemia,
Tigecycline hypoglycaemia.
 STABILITY/
LOCAL
ACTIVE INGREDIENT; SOLVENT FOR DILUTION INCOMPATIBILITIES ¹ GENERAL ADULT MINIMUM MAXIMUM STORAGE OF PORPHYRIA
TRADENAME(S) INJECTION SITE ALLERGY PROFILE ¹ ²
STRENGTH & (CLASS) RECONSTITUTION (after reconstitution) ² DOSE* ¹ ² ⁵ INFUSION TIME INFUSION TIME ¹ ² DILUTED RISK
REACTIONS
SOLUTION ¹ ²

*The general adult doses are for Adults with normal renal function
**Complete description of a typical penicillin allergy
***Recommended reconstitution and dilution method
The following formula may be used to calculate Creatinine Clearance (CrCl):
Men: Creatinine Clearance (ml/min) = Weight (kg) x (140 – Age)
0.82 x serum creatinine (µmol/L)
Women: 0.85 x the value calculated for men.
If the calculated CrCl is below 50ml/min, dosages of renally excreted drug dosages should usually be decreased accordingly (Refer to Sanford Guideline)

REFERENCES:
1) Package insert and EMGuidance App.
2) Lexicomp Online® , Pediatric & Neonatal Lexi-Drugs® , Hudson, Ohio: Lexi-Comp, Inc.; 2020.
3) Rossiter D. 2014. South African Medicines Formulary. 11th ed. Cape Media House, Rondebosch, South Africa.
4) Labuschagne Q, Schellack N, Gous A, et al., 2016. COLISTIN: adult and paediatric guideline for South Africa, 2016. Southern African Journal of Infectious Diseases; 1(1):1–5.
Available from: http://Diagnosis.doi.org/10.1080/23120053.2016.1144285
5) Petrosillo N, Giannella M, Lewis R & Viale P. 2013. Treatment of carbapenem-resistant Klebsiella pneumoniae: the state of the art. Expert Review of Anti-Infective Therapy; 11(2): 159–177.
6) Pea F & Viale P. 2009. Bench-to-bedside review: Appropriate antibiotic therapy in severe sepsis and septic shock - does the dose matter? Critical Care ; 13:214.
7) Richards GA, Joubert IA & Brink AJ. 2015. Optimising the administration of antibiotics in critically ill patients. SAMJ ; 105(5). Available from: http://www.samj.org.za/index.php/samj/article/view/10003/6734
8) Kaye KS, Pogue JM & Kaye D. Polymyxins (Polymyxin B and Colistin). In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 32, 405-409. 9th Ed.
Available from: https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323482554000321?scrollTo=%23hl0000497

Additional References:
Mc Auley, D. 2015. Global RPh. The Clinician's Ultimate Reference. Colistimethate sodium (Colistin) - Coly-Mycin®. Accessed on: 25 November 2015. Available from: http://www.globalrph.com/colistin_dilution.htm
EMC. 2015. Colomycin bolusection. Forest Laboratories UK Limited (a subsidiary of Actavis PLC) Accessed on: 25 November 2015. Available from: https://www.medicines.org.uk/emc/medicine/1590
Monthly Index of Medical Specialities. 2015. Volume 55, Number 6. CTP Printers, Cape Town, South Africa.
http://www.fda.gov/ohrms/dockets/dockets/06p0245/06P-0245-EC12-Attach-1.pdf
http://www.medsafe.govt.nz/profs/datasheet/p/penicillingbolus.pdf
http://apps.who.int/medicinedocs/en/d/Jh2918e/23.2.html#Jh2918e.23.2
http://www.ukessays.com/essays/nursing/review-literature-on-thromboLOCAL bolusECTION SITE REACTIONS-treatment-with-alovera-gel-nursing-essay.php
http://reference.medscape.com/drug/cefpirome-342512#4
http://www.merckmanuals.com/professional/infusionectious-diseases/bacteria-and-antibacterial-drugs/chloramphenicol
http://www.drugs-porphyria.org/languages/UnitedKingdom/s1.php?l=gbr
http://www.porphyriafoundation.com/drug_database/

VERSION CONTROL:
Version 1: First publication
COMPILED BY: M. COETZEE, A. VAN JAARSVELD & E. WATKINS
DATE: January 2017
Revised (Version 2): Polymyxin B and two new BL/BLI added
REVIEWED WITH INPUT FROM: M. COETZEE, A. VAN JAARSVELD, E. WATKINS, L. CILLIERS, M. DREYER, M. LOOTS & M. DU TOIT
DATE: July 2020

FOR CRITICALLY ILL PATIENTS, PRESENTING WITH SEPSIS:

Refer to the 'Optimising Antimicrobial Therapy Guideline' (on the intranet)
 STABILITY/
LOCAL
ACTIVE INGREDIENT; SOLVENT FOR DILUTION INCOMPATIBILITIES ¹ GENERAL ADULT MINIMUM MAXIMUM STORAGE OF PORPHYRIA
TRADENAME(S) INJECTION SITE ALLERGY PROFILE ¹ ²
STRENGTH & (CLASS) RECONSTITUTION (after reconstitution) ² DOSE* ¹ ² ⁵ INFUSION TIME INFUSION TIME ¹ ² DILUTED RISK
REACTIONS
SOLUTION ¹ ²

List of Abbreviations
ALT alanine transaminase LFT's Liver function tests
AST aspartate transaminase MAOI's monoamine oxidase inhibitors
βL Beta-lactamase Max maximum
C. diff. Clostridium difficile mcg microgram
CAP community acquired pneumonia µmol micromoles
CF Cystic fibrosis mg milligram
CMS Colistimethate sodium MgSO4 magnesium sulphate
contin. continuous Min minimum
Co-TMX Co-trimoxazole mL or ml millilitre
CrCl Creatinine Clearance MU million units
D10W dextrose 10% in water N/A Not applicable
D20W dextrose 20% in water NB (Latin, nota bene ) means "note well"
D5W dextrose 5% in water NS Sodium chloride 0.9% (normal saline)
D5NS dextrose 5% in sodium chloride 0.9% PI Package Insert
div divided q12h every 12 hours
Diagnosis diagnosis q24h every 24 hours
eGFR Estimated Glomerular Filtration Rate q48h every 48 hours
FDA Food and Drug Association q6h every 6 hours
FKSA Fresenius Kabi South Africa q72h every 72 hours
fx function q8h every 8 hours
g gram RL ringers lactate
HAP hospital acquired peumonia Room temp Room temperature (<25°C)
HES hydroxyethyl starch Rx prescription
HIV Human immunodifficiency virus SC subcutaneous
IBW Ideal body weight SJS Steven Johnson Syndrome
IM Intramuscular TB Tuberculosis
inj injection TPN total parenteral nutrition
IV Intravenous u units
L litre VRE vancomycin resistant enterobacteriaciae
LD Loading Dose Wt weight