Effects of amino acid infusions on doripenem injection at the Y-site

• Published in: Japanese Journal of Chemotherapy Vol. 56; no. 1; pp. 1 - 6
• Main Authors: Yoshioka, Mutsunobu, Takenaka, Masahiko, Shundo, Kazuyo, Orita, Tamaki, Shin, Yasunori, Watari, Masakatsu
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of Chemotherapy 01.01.2008; 公益社団法人 日本化学療法学会
• Subjects: amino acid infusion; carbapenem; doripenem; Y-site injection
• ISSN: 1340-7007; 1884-5886
• DOI: 10.11250/chemotherapy1995.56.1

It has been reported that the blood levels of carbapenems decline markedly when they are administered in combination with amino acid infusions, including those of L-cysteine and L-cystine. However, although antibiotic injections are widely administered through a Y-site with total parenteral nutrient (TPN) and peripheral parenteral nutrient (PPN) solutions containing amino acids in many clinical situations, there have beenno reports of the influence of such administration on the clinical efficacy of the drugs. We studied the influence of carbapenem injection at the Y-site on the clinical efficacy of the drugs, by injection of doripenem (DRPM), which is a carbapenem drug, through the Y-site with TPN and PPN solutions containing amino acids, and determining if this method of injection increased the risk of decline in the blood levels of carbapenems. We enrolled 97 cases in which DRPM injections were given during the 6 monthsfrom May to October 2006. The patients were classified into a contact group (or Amino acid group), in which the DRPM injections were injected at the Y-site with amino acid infusions, and a non-contact group (or Non amino acid group), in which DRPM injections were administered through a separate dedicated line. There were 47 cases in the Amino acid group and 50 cases in the Non amino acid group. The study on the risk factors indicated that the odds ratio of DRPM injection through the Y-site along with amino acid infusions for the decline of fever was 0249 (95% confidence interval: 0.088-0.708), demonstrating that injection through the Y-site was an obvious risk factor for drug level decline. Furthermore, the rates of resolution of fever and decrease of the WBC counts after DRPM treatment in the Amino acid group were significantly lower than those in Non amino acid group (P<0.05). Our results suggested that TPN and PPN solutions containing amino acids decreased the clinical efficacy of DRPM. In conclusion, carbapenems should be administered through a separate dedicated line or through a Y-site after temporary discontinuation of TPN or PPN infusion.