Stability and compatibility of amikacin and its combination antibiotics in 7.5% icodextrin peritoneal dialysis solution

Introduction: The study aimed to evaluate the stability and compatibility of diverse antibiotics in 7.5% icodextrin peritoneal dialysis (PD) solution, subjected to various temperatures over a span of 14 days period. Methods: Antibiotics, namely amikacin, imipenem, ciprofloxacin, vancomycin and cefazolin, were incorporated into 7.5% icodextrin solution and subsequently stored at various temperature and period. The concentrations of these antibiotics were measured using high-performance liquid chromatography. Stability of antibiotics is defined as the remaining drug concentration > 90% of the initial one throughout the test period. Results: Ciprofloxacin and amikacin were demonstrated stable for a period of 14 days in icodextrin solution across all tested temperatures. Amikacin retained over 90% of its initial concentration when combined with either vancomycin, cefazolin, or ciprofloxacin at various temperatures for 14 days. In combination with amikacin, ciprofloxacin maintained stability for 14 days at all tested temperatures, while vancomycin maintained stability for 14 days at both 4 ℃ and 25℃, and 7 days at 37℃. Cefazolin, however, only exhibited stability for 8 hours at 37°C and 7 days at both 4°C and 25°C. The stability of imipenem in icodextrin solution was notably low, remaining stable for a maximum 6 hours at 4°C. Conclusion: Ciprofloxacin, amikacin, as well as combinations of amikacin and vancomycin, amikacin and cefazolin, amikacin and ciprofloxacin, can be added to icodextrin solution for treatment of peritoneal dialysis associated peritonitis because they maintain stability for a minimum of 7 days at the temperatures of 4℃ and 25℃, and 8 hours at 37℃.