Browse the corpus

©2013 UpToDate ® Print Email Final concentrations of antibiotic lock solutions without anticoagulant for treatment of catheter-related bloodstream infections Antibiotic and concentration Maximum dwell time (duration of stability) References Amikacin 1 mg/mL 48 hours [1] Aztreonam 83.3 mg/mL 12 hours [2] Cefepime 1 mg/mL 48 hours [1] Cefepime 10 mg/mL 48 hours [1] Ceftazidime 5 mg/mL 48 hours [1] Ceftriaxone 83.3 mg/mL 12 hours [2] Ciprofloxacin 5 mg/mL 48 hours [3] Daptomycin 5 mg/mL* 72 hours [4] Gentamicin 13.3 mg/mL 12 hours [2] Minocycline 2 mg/mL 4 hours [5] Nafcillin 83.3 mg/mL 12 hours [2] Rifampicin 5 mg/mL 48 hours [3] Teicoplanin 10 mg/mL 48 hours [3] Tigecycline 2 mg/mL 4 hours [5] Vancomycin 5 mg/mL 72 hours [4] Combinations Daptomycin 2 mg/mL* and rifampin 2 mg/mL 4 hours [5] Linezolid 2 mg/mL and rifampin 2 mg/mL 4 hours [5] Minocycline 2 mg/mL and rifampin 2 mg/mL 4 hours [5] Tigecycline 2 mg/mL and rifampin 2 mg/mL 4 hours [5] Vancomycin 2 mg/mL and rifampin 2 mg/mL 4 hours [5]

Teicoplanin 10 mg/mL 48 hours [3] Tigecycline 2 mg/mL 4 hours [5] Vancomycin 5 mg/mL 72 hours [4] Combinations Daptomycin 2 mg/mL* and rifampin 2 mg/mL 4 hours [5] Linezolid 2 mg/mL and rifampin 2 mg/mL 4 hours [5] Minocycline 2 mg/mL and rifampin 2 mg/mL 4 hours [5] Tigecycline 2 mg/mL and rifampin 2 mg/mL 4 hours [5] Vancomycin 2 mg/mL and rifampin 2 mg/mL 4 hours [5] This table lists clinically useful antibiotic solutions that do not contain an anticoagulant and can be used in patients who have a contraindication to heparin. Otherwise, solutions containing both an antibiotic and an anticoagulant are preferred. The doses included have optimal stability and/or in vitro data to support their use. Antibiotic lock solutions for the treatment of catheter-related bloodstream infections should be used in conjunction with systemic antibiotic therapy. Antibiotic concentrations may decrease to subtherapeutic levels in the distal lumen of the catheter when dwell times exceed 48 hours, but for hemodialysis catheters, it is reasonable to allow the solution to dwell during the interval between sessions, up to 72 hours. If the line must be accessed for alternate use during the dwell time, the lock solution should be removed and later replaced anew. * Daptomycin solution contained 50 mg/L of calcium, which is necessary for antibiotic activity. 1. Lee MY, Ko KS, Song JH, Peck KR. In vitro effectiveness of the antibiotic lock technique (ALT) for the treatment of catheter-related infections by Pseudomonas aeruginosa and Klebsiella pneumoniae. J Antimicrob Chemother 2007; 60:782. 2. Andris DA, Krzywda EA, Edmiston CE, et al. Elimination of intraluminal colonization by antibiotic lock in silicone vascular catheters. Nutrition 1998; 14:427. 3. Lee JY, Ko KS, Peck KR, et al. In vitro evaluation of the antibiotic lock technique (ALT) for the treatment of catheter-related infections caused by staphylococci. J Antimicrob Chemother 2006; 57:1110. 4. LaPlante KL, Mermel LA. In vitro activity of daptomycin and vancomycin lock solutions on staphylococcal biofilms in a central venous catheter model. Nephrol Dial Transplant 2007; 22:2239. 5. Raad I, Hanna H, Jiang Y, et al. Comparative activities of daptomycin, linezolid, and tigecycline against catheter-related methicillin-resistant Staphylococcus bacteremic isolates embedded in biofilm. Antimicrob Agents Chemother 2007; 51:1656.