Augmentin stability

Re: Augmentin stability

Clive Ansell — Sun, 18 Apr 2010 19:19:57 GMT

Regardless of the cost, open a new vial, use what you need, throw the remainder and just bill the client for the vial - problem solved.

Re: Augmentin stability

Evelyn Barbour-Hill — Sun, 18 Apr 2010 17:12:19 GMT

[quote user="Chris Aylott"]In the absence of that I am going to continue to discard it after 20 minutes- on a precautionary princple- and gently encourage my colleauges to do the same.[/quote]

And it's cheap, so why not?

Re: Augmentin stability

Chris Aylott — Fri, 16 Apr 2010 09:31:08 GMT

I have enjoyed following this thread- It's been an interesting and at times entertaining tour around alternatives to using Augmentin, indications for it and even the obligatory poke at the homeopaths however I am pleased that Antony has brought us full circle.

Is anyone aware of any real science that tells us if Augmentin is effective after it's gone brown?

In the absence of that I am going to continue to discard it after 20 minutes- on a precautionary princple- and gently encourage my colleauges to do the same.

I cant believe that GSK would have gone to all the trouble to estabilish it's stability at different concentrations and temperatures as described in the human product information sheet if it was in fact stable reconstituted in the bottle.

Re: Augmentin stability

Anthony Todd — Fri, 16 Apr 2010 00:04:54 GMT

We should realise that we are always governed by the datasheet which is legally and scientifically binding, but prepared by the manufacturer therefore not independent

The 28 day discard requirement is a typical example. The drug was shown to be effective at 28days but was not tested at 29 days or 29 months.

It is incredible beyond belief [to quote Ned Sherrin] that all pharmaceutical injectables become totally ineffective at 28 days and 1 second and, of course, why would the manufacturers want us not to believe that......

Convenia is just as effective when it is brown, must be, it's in the datasheet and one wonders if colour change in Augmentin is significant??

Re: Augmentin stability

Evelyn Barbour-Hill — Thu, 15 Apr 2010 19:30:25 GMT

[quote user="Catherine Williams"]

[quote user="Clive Ansell"]what do you use for really badly infected dentals that have not had pre op antibiosis?. I prefer 5-7 days ab's prior to the procedure, but as a locum I often get them that have not had any. i used to use Augmentin +/- metronidazole i/v with these, but now I use Synulox +/- Metronidazole or Antirobe and inject/give capsule on admission for the op. [/quote]

I'm going from memory but I'm fairly sure that one of the dentistry references I've got suggested not to use pre-op antibiotics as you were likely to select for more resistant bacteria that would then be scattered in the inevitable bacteraemic shower during the dental descale. The recommendation was to use synulox im immediately after induction - less painful when the patient is asleep and reached effective levels quickly enough to mop up any bacterial scatter. I've been following this advice for the last yr or 2 and it seems to work well - the nurses do pull a few faces on giving the synulox im tho!

[/quote]

Yes, the pre-op course of antibiotic is not very logical - what is it trying to achieve? And indeed it will be selecting antibiotic-resistant bacteria. If you are going to use an antibiotic (which I don't always) then you need a big dose a little before you start, so that blood levels are bactericidal while you're doing the job, and the blood that forms the clots afterward is loaded with antibiotic. Clavulanate-amoxycillin is just the job. I can't quote a reference offhand, but I don't think adding metronidazole brings any advantage although it seems as if it "ought" to.

[quote user="Catherine Williams"]the nurses do pull a few faces on giving the synulox im tho![/quote]

Why?

Re: Augmentin stability

Catherine Williams — Thu, 15 Apr 2010 17:18:56 GMT

Re: Augmentin stability

Matt Gurney — Thu, 15 Apr 2010 16:36:32 GMT

I think it is time to put this dreadful science to bed. The whole concept of using a drug as a cri without understanding of pharmacokinetics is inaccurate and the use of an antibiotic in such a way is a prime example of professional abuse of such a precious and potentially dangerous resource. If you are willing to deal with the consequences of antibiotic resistance following elective surgery then carry on.

Re: Augmentin stability

Clive Ansell — Thu, 15 Apr 2010 14:53:31 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Clive Ansell"] I am not sure about mixing in a drip bag for constant rate infusion, not sure how/if it would react or be deactivated, by saline or Hartman's etc.[/quote]

Wouldn't you need to know a great deal about the pharmacodynamics (is that the right word?) before you could decide how much to put in the drip bag and what infusion rate to use...... and then suppose the drip rate had to be turned up or turned down for other reasons?

[/quote]

I don't think I would put it in a drip bag at all, because as you say there is uncertainty over its stabilty, its pharmacodynamics, and at what rate to give it. If I do use it, it is given as a one off i/v bolus, and followed up with synulox.

Evelyn. what do you use for really badly infected dentals that have not had pre op antibiosis?. I prefer 5-7 days ab's prior to the procedure, but as a locum I often get them that have not had any. i used to use Augmentin +/- metronidazole i/v with these, but now I use Synulox +/- Metronidazole or Antirobe and inject/give capsule on admission for the op.

Re: Augmentin stability

Evelyn Barbour-Hill — Thu, 15 Apr 2010 14:41:44 GMT

[quote user="Chris Aylott"]the more you dilute it the longer it is stable for.[/quote]

Why is that? Or, the same question in a different way I suppose, what is the mechanism of the instability?

Re: Augmentin stability

Evelyn Barbour-Hill — Thu, 15 Apr 2010 14:39:29 GMT

[quote user="Clive Ansell"] I am not sure about mixing in a drip bag for constant rate infusion, not sure how/if it would react or be deactivated, by saline or Hartman's etc.[/quote]

Re: Augmentin stability

Clive Ansell — Wed, 14 Apr 2010 13:00:50 GMT

I used to use Augmentin a fair bit, particularly for really bad dentals where no pre op antibiosis had been used. I have stopped doing so since the discussion on this thread, They now get s/c synulox on admission which is often 2-3 hours prior to the procedure. No problems to date.

That said, I did use i/v augmentin yesterday in a very ill, and very collapsed and dehydrated Westie with a pyometra, I'm not sure how long it would take to reach serum level with such a collapsed circulation and thought i/v would be very much quicker. Just an assumption though. I am not sure about mixing in a drip bag for constant rate infusion, not sure how/if it would react or be deactivated, by saline or Hartman's etc.

On a similar note, I was interested to learn at a recent OA cpd roadshow, where Malcomb was one of the speakers, that oral administered Previcox will reach serum levels quicker than other nsaid's given by s/c injection.

Re: Augmentin stability

Chris Aylott — Wed, 14 Apr 2010 07:39:09 GMT

From a stability point of view this makes some sense, the more you dilute it the longer it is stable for.

From an indication point of view I am persuaded by Malcolm's posts- a well timed injection of synulox/noraclav will achieve the same levels as the i/v very quickly in a hydrated patient, and you wouldn't be likely to be doing orthopaedic surgery in a dehydrated one.

Re: Augmentin stability

jewel1973 — Wed, 14 Apr 2010 00:54:56 GMT

has anyone used augmentin in an iv infusion?,

wherever i have worked it has been discarded after 20 mins, when it turns a yellow colour.

i have recently witnessed its use as follows

standard dose given iv, then rest of vial into drip bag

this has been for perioperative antibiosis for orthopaedic surgery.

any thoughts on this?

Re: Augmentin stability

Niall Taylor — Mon, 01 Mar 2010 21:39:45 GMT

[quote user="Clive Ansell"]Easy. just create a homoeopathic vaccine by crushing a car and diluting it by a factor of 10,000,000[/quote]

Tsk... You're talking about isopathy here - your crushed, diluted car tincture is a nosode, not a homeopathic remedy.

And 10,000,000 is actually very concentrated - so concentrated that it would probably be completely ineffective.

Niall

Re: Augmentin stability

HMC — Mon, 01 Mar 2010 21:23:35 GMT

[quote user="phipps"]

I tend to limit my use of IV antibiosis to cases that have or might have decreased tissue perfusion such that s/c or im abs might have poor absorbtion from these tissues and not reach effective concentration in blood - eg sepsis, sirs and other types of shock or hypovolaemia. Once perfusion is restored, I can't see any good reason to continue with iv abs.

[/quote]

There are good points made in this debate. I had just accepted the 'truth' that iv antibiotics are more potent, from both uni and one place I worked in particular. It is not something I had ever really thought about but just followed the train of thought that a hospitalised in-patient with iv access might as well have any antibiotics it needs iv too. I need to reconsider my approach now.

Also, I could swear that augmentin lasted for 24hrs in the fridge, without any special dilution. Having just checked the datasheet I realise I am wrong- and from now on will be discarding it immediately after injection (prob easiest). Has the datasheet changed, does anyone know or or was I making up the 24hr limit in the first place???

Lastly, does anyone other than myself have any qualms about injecting medications iv from bottles that have been open for an indeterminate amount of time, eg marbocyl?

Re: Augmentin stability

J G Wray — Thu, 04 Feb 2010 15:51:09 GMT

[quote user="jen swift"]coloidal silver, cats claw bark, belladonna in homeopathic doses can stimulate the immune system without deplition.. avioding possible surgery.. [/quote]

Is there good money in homeopathy?

JGW

Re: Augmentin stability

Malcolm Ness — Thu, 04 Feb 2010 14:38:49 GMT

Apparently St John's Wort is very good for hysteria.

Re: Augmentin stability

Arlo Guthrie — Thu, 04 Feb 2010 13:20:30 GMT

For the moment at least, I'm thinking we need to start a new 'hysterical' section.

Re: Augmentin stability

Gillian Mostyn — Thu, 04 Feb 2010 12:20:28 GMT

now now....you'll end up relegating this thread to the controversial section.....

Re: Augmentin stability

Ian Mostyn — Thu, 04 Feb 2010 11:42:23 GMT

Would that be a preventative dose or to treat the effects post RTA? Would the make and model of the car matter or could we collect a polyvalent vaccine with most common models included? We could have a different version for german, french or japanese cars. No need for the British version though.....

Wouldn't you have to add some tarmac to the mix and maybe the odd pothole to be most effective?

Ian

Re: Augmentin stability

Clive Ansell — Thu, 04 Feb 2010 11:07:05 GMT

[quote user="Malcolm Ness"]

Puzzled as to how surgery to repair, for example, a fractured femur and pelvis occassioned by the patient being smacked firmly by a moving car might be avoided by "stimulating the immune system".

[/quote]

Easy. just create a homoeopathic vaccine by crushing a car and diluting it by a factor of 10,000,000. Then just give 6 drops every leap year

Re: Augmentin stability

Matt Gurney — Thu, 04 Feb 2010 10:09:59 GMT

I always discard after 20 mins. This has been standard practice wherever I have worked.

Re: Augmentin stability

Gillian Mostyn — Thu, 04 Feb 2010 09:58:22 GMT

me too!

Re: Augmentin stability

Malcolm Ness — Thu, 04 Feb 2010 08:53:03 GMT

Not entirely sure what the previous post has got to do with the post but I will need to see something more than the faith of mystic medics to convonce me of this assertion.

Puzzled as to how surgery to repair, for example, a fractured femur and pelvis occassioned by the patient being smacked firmly by a moving car might be avoided by "stimulating the immune system".

Re: Augmentin stability

jen swift — Thu, 04 Feb 2010 00:39:03 GMT

[quote user="Malcolm Ness"]

I know all the info about pre surgical antibiotic use and I am aware that IV antibiotics, esp potentiated amoxycillin or fancy cephalosporins, are very widely used.

.........but ........ a few years ago we did a literature review on this and confirmed that following either IM or sub cut injection of regular synulox/nisamox etc injectable , each of the active ingredients appears to reach effective plasma levels very, very quickly. I can't remember the exact numbers but it was in the range of seconds to a few minutes. Consequently, we now use a single IM injection of potentiated amoxycillin given as the patient is draped for surgery. Several residents have questioned the practice but, having been sent away to repeat the review they have come round to our way.

Does anybody out there know anything we don't?

Malcolm N

[/quote]

coloidal silver, cats claw bark, belladonna in homeopathic doses can stimulate the immune system without deplition.. avioding possible surgery..