CGH Dilution and Administration Guidelines Antibiotics

CHANGI GENERAL HOSPITAL

DILUTION AND ADMINISTRATION GUIDELINES
ANTIMICROBIALS

DRUG NAME POSSIBLE DILUENT(S) MAXIMUM APPROXIMATE MAXIMUM POSSIBLE ROUTE(S) OF INCOMPATIBILITIES/
(BRAND NAME) CONCENTRATION PERIOD OF PERIOD OF ADMINISTRATION SPECIAL INSTRUCTIONS
References AFTER DILUTION STABILITY AT STABILITY AT
25C 4C#
Aciclovir IV - 10 mL WFI or normal 7 mg/mL 12 hours Do NOT IV - Intermittent IV infusion (using Do not refrigerate as this may
Inj 250 mg saline, followed by refrigerate infusion pump) over at least 1 cause precipitation of crystals.
further dilution to 100 mL hour (*)
1,6 with normal saline or Patient should be adequately
D5% hydrated during treatment,
especially during first few hours of
infusion

Amikacin Inj IV - Further dilution to 100-200 5 mg/mL 24 hours 60 days IV - Intermittent IV infusion over 30 Should not be mixed in the same
500 mg/2 mL mL with normal saline or 60 minutes (*) container with -lactam antibiotics
(Likacin ) D5% (*) (e.g. penicillin G, cloxacillin,
If dose is 1g or more, infuse over 60 cephazolin) and vancomycin as
1,2,5 minutes this will lead to inactivation of
amikacin
DO NOT ADMINISTER AS IV
BOLUS Use with caution with drugs that
are nephrotoxic or ototoxic
IM Pre-reconstituted 250 mg/mL - - IM - Deep IM injection into infected
Area

Amoxicillin/ IV - 20 mL WFI 57.4 mg/mL 4 hours 8 hours IV - Slow IV bolus injection over 3-4 Should not be reconstituted with
Clavulanic Acid (Final volume = 20.9 mL, minutes or added to any solution
Inj 1.2 g use within 20 min after containing dextrose (e.g. D5%),
(Augmentin ) reconstitution) dextran or bicarbonate

1 Should not be mixed in the same

IV - As above, followed by 12 mg/mL 4 hours 8 hours IV - Intermittent IV infusion over 30- container with aminoglycoside
further dilution to 100 mL 40 minutes (*) antibiotics as this will lead to
with normal saline (*) inactivation of the aminoglycoside

Should not be mixed in the same

container with blood products,
protein hydrosylates or lipid
emulsions

(*) indicates the preferred method/duration of administration; some injections are not available in CGH # Reconstituted injections are recommended to be used within 24 hours 1
 CGH Dilution and Administration Guidelines Antibiotics
DRUG NAME POSSIBLE DILUENT(S) MAXIMUM APPROXIMATE MAXIMUM POSSIBLE ROUTE(S) OF INCOMPATIBILITIES/
(BRAND NAME) CONCENTRATION PERIOD OF PERIOD OF ADMINISTRATION SPECIAL PRECAUTIONS
References AFTER DILUTION STABILITY AT STABILITY AT
25C 4C#
Ampicillin IV 5 mL WFI 83 mg/mL 1 hour 24 hours IV - Slow IV bolus injection over 3-5 Should not be mixed in the same
Inj 500 mg minutes container with aminoglycoside
antibiotics as this will lead to
1,2,5 IV - As above, followed by 30 mg/mL 8 hours 48 hours IV Intermittent IV infusion over 15- inactivation of the aminoglycoside
further dilution to 50 mL 20 minutes (*)
with normal saline (*) Should not be mixed in the same
container with blood products,
IM 5 mL WFI 250 mg/mL 6 hours 24 hours IM - Deep IM injection into gluteal protein hydrosylates or lipid
muscle or thigh muscle emulsions

Ampicillin/ IV - 3.2 mL normal saline or 250 mg/mL 8 hours - IV - Slow IV bolus injection over 3-5 Should not be mixed in the same
Sulbactam WFI, allow to stand until minutes container with aminoglycoside
Inj 1.5 g mixture is clear antibiotics as this will lead to
(Unasyn) inactivation of the aminoglycoside
IV - As above, followed by 45mg/mL 8 hours 72 hours IV - Intermittent IV infusion over 15-
1,2,5,6 further dilution to Stability in 30 minutes (*) Should not be mixed in the same
50100 mL with normal D5% is only container with blood products,
saline or WFI (*) 4hrs protein hydrosylates or lipid
emulsions

IM 3.2 mL WFI or lignocaine 250 mg/mL 1 hour - IM - Deep IM injection into gluteal
0.5% to reach a total muscle or thigh muscle
volume of 4 mL

Amphotericin B IV - 10 mL WFI, shake 0.1 mg/mL 24 hours 24 hours IV - Intermittent IV infusion over 6 Reconstituted solution must be
(Conventional) vigorously until solution hours (*) protected from light to prevent
Injection 50mg is clear, followed by drug degradation
further dilution to 500 mL (N.B. A test dose of 1mg, i.e., 0.2
1 with D5% (*) mL in 20 mL D5%, may be given to Do not reconstitute with sodium
the patient; and patients blood chloride (saline) solutions
pressure, heart rate, temperature
and respiration monitored every 30
minutes for 2-4 hours)

BLADDER IRRIGATION - 0.05 mg/mL 24 hours - a) Infuse 200 mL of reconstituted

10 mL sterile water, shake solution through a 3-way
vigorously until solution is indwelling urinary catheter.
clear, followed by further b) Cross-clamp the catheter for
dilution to 1000 mL with sterile 60-90 minutes after which the
water. bladder should be emptied.
c) Repeat the procedure 5 times
daily.

(*) indicates the preferred method/duration of administration; some injections are not available in CGH # Reconstituted injections are recommended to be used within 24 hours 2
 CGH Dilution and Administration Guidelines Antibiotics
DRUG NAME POSSIBLE DILUENT(S) MAXIMUM APPROXIMATE MAXIMUM POSSIBLE ROUTE(S) OF INCOMPATIBILITIES/
(BRAND NAME) CONCENTRATION PERIOD OF PERIOD OF ADMINISTRATION SPECIAL PRECAUTIONS
References AFTER DILUTION STABILITY AT STABILITY AT
25C 4C#
Anidulafungin IV Reconstitute each 100mg 3.33 mg/mL 24 hours Do NOT IV Intermittent IV infusion.
Inj 100mg vial with 30 mL WFI refrigerate For 100 mg dose over 90 minutes
(Eraxis) For 200 mg dose - over 3 hours.
Add reconstituted solution
1,3 (100 mg in 30 mL) to normal
saline or D5% 0.77 mg/mL Rate of infusion should not exceed
1.4 mL/min (1.1 mg/min)
100 mg dose (in 30 mL)
- Add to 100 mL to form total DO NOT ADMINISTER AS
infusion volume of 130 mL IV BOLUS

200 mg dose (in 60 mL)

- Add to 200 mL to form total
infusion volume of 260 mL

Artesunate Reconstitute with 1 ml of 10mg/ml To be used To be used IV- Administer IV slowly at rate of
Inj 5% sodium biocarbonate immediately immediately 3 - 4ml/min
60mg vial solution (provided) and
shaken 2-3 minutes for
1 better dissolution

IV: Add 5 ml of D5% or normal

saline to
make the concentration of
Artesunate in 10 mg/ml
20mg/ml To be used To be used IM (to anterior thigh)
IM: Add 2 ml of D5% or normal immediately immediately
saline to make the
concentration of
Artesunate in 20 mg/ml

Azithromycin IV 4.8 mL WFI and shake till 2mg/mL 24 hours 7 days IV Intermittent IV infusion over at Should not add other IV
Inj 500 mg powder has dissolved. least 60 minutes substances, additives or
(Zithromax) Further dilution to 250 mL medications or infuse other drugs
or 500 mL with normal DO NOT ADMINISTER AS IM OR simultaneously through same IV
1,2,5 saline or D5%. IV BOLUS line

(*) indicates the preferred method/duration of administration; some injections are not available in CGH # Reconstituted injections are recommended to be used within 24 hours 3
 CGH Dilution and Administration Guidelines Antibiotics
DRUG NAME POSSIBLE DILUENT(S) MAXIMUM APPROXIMATE MAXIMUM POSSIBLE ROUTE(S) OF INCOMPATIBILITIES/
(BRAND NAME) CONCENTRATION PERIOD OF PERIOD OF ADMINISTRATION SPECIAL PRECAUTIONS
References AFTER DILUTION STABILITY AT STABILITY AT
25C 4C#

Aztreonam IV - 10 mL WFI, followed by 75.2 mg/mL 24 hours 72 hours IV - Slow IV bolus injection over 3-5 Final concentration should not
Inj 1 g vigorous shaking minutes exceed 2% w/v (20 mg/mL)
(Azactam)
IV- As above, then further 20 mg/mL 24 hours 72 hours IV - Intermittent IV infusion over 20- Physically incompatible with
1 dilute to 50100 mL with 60 minutes (*) metronidazole injection
normal saline or D5% (*)

IM 3 mL normal saline or 250 mg/mL 24 hours 72 hours IM - Deep IM injection into outer
WFI to form a total quadrant of gluteal muscle or
volume of 4 mL lateral part of thigh

BENZATHINE IM - 5 to 8 mL WFI dependent
Benzylpenicillin (IM) on brand (*)
2.4 MU Injection Shake vigorously for 20 sec
(N.B. Final reconstituted
1 product is a suspension of
about 6 to 8 mL, dependent on
brand)
0.3 to 0.4 MU/mL Brand - IM - Slow deep IM injection into When repeating doses, vary the
(dependent on dependent upper outer quadrant of gluteal injection site
brand) muscle using 18-20G needle
Inject 2 doses of 3 to 4 mL (volume
dependent on brand) into 2
different injection sites
(Maximal volume tolerated at a
given injection site is 5 mL)

NOT FOR IV OR SUBCUT USE

Caspofungin IV - Bring the refrigerated vial 7 mg/mL - 24 hrs IV Intermittent IV infusion over Do not use any diluents
Inj 70 mg to room temp. (70-mg vial) 1 hr containing dextrose.
& Inj 50 mg Reconstitute with 10.5 mL or 5 mg/mL
(Cancidas) of WFI. (50-mg vial). Vol of reconstituted solution Do not mix or co-infuse with any
required for further dilution other medications.
1 70-mg dose withdraw 10 mL from
Withdraw required amount of 0.5 mg/mL 24 hrs 48 hrs reconstituted 70 mg vial Do not use if the solution is cloudy
reconstituted solution for dose, or precipitated.
and further dilute to 250ml with 50-mg dose- withdraw 10 mL from
normal saline (*). May be 50 mg vial
diluted to 100 mL for 50- or
35-mg daily doses. 35-mg dose- withdraw 7 mL from
reconstituted 50 mg vial

(*) indicates the preferred method/duration of administration; some injections are not available in CGH # Reconstituted injections are recommended to be used within 24 hours 4
 CGH Dilution and Administration Guidelines Antibiotics
DRUG NAME POSSIBLE DILUENT(S) MAXIMUM APPROXIMATE MAXIMUM POSSIBLE ROUTE(S) OF INCOMPATIBILITIES/
(BRAND NAME) CONCENTRATION PERIOD OF PERIOD OF ADMINISTRATION SPECIAL PRECAUTIONS
References AFTER DILUTION STABILITY AT STABILITY AT
25C 4C#
Cefepime IV- 10 mL WFI, normal 160 mg/mL 24 hours 7 days IV Slow IV bolus injection over 3-5 Should not be mixed in the same
Inj 2 g saline or D5% minutes container with aminoglycoside
(Maxipime) antibiotics, vancomycin,
IV- As above, followed by 40 mg/mL 24 hours 7 days IV Intermittent IV infusion over 30 metronidazole or aminophylline
1 further dilution to 50 mL minutes (*) due to physical or chemical
with normal saline or D5% incompatibility.

IM - Dilute in 6 mL WFI, 230 mg/mL 24 hours 7 days IM Deep IM injection into gluteal Should not be mixed in the same
normal saline or D5% muscle or thigh muscle. The container with blood products,
maximum IM dose should be protein hydrosylates or lipid
injected at 2 different sites emulsions

Cefoxitin IV 10 mL WFI 95 mg/mL - - IV Slow IV bolus injection over 3-5 Should not be mixed in the same
Inj 1 g minutes container with aminoglycoside
IV As above, then further antibiotics
1,2 dilute with 50-100 mL of 40 mg/mL 24 hours 7 days IV Intermittent IV infusion over 30
normal saline or D5% minutes

IM Reconstitute with 2 mL 400 mg/mL - - IM Deep IM injection into gluteal

lignocaine 1% or WFI muscle or thigh muscle

Ceftazidime IV 10 mL normal saline or 40 mg/mL 6 hours 72 hours IV - Intermittent IV infusion over 30 Should not be mixed in the same
Inj 1 g WFI, followed by further minutes (*) container with aminoglycoside
dilution to 50 mL with
1,2 normal saline Should not be mixed in the same
container with blood products,
IM 3 mL of lignocaine 1% or 260 mg/mL - - IM Deep IM injection into gluteal protein hydrosylates or lipid
WFI or lateral thigh muscle. emulsions

Should not be diluted in sodium

bicarbonate injection due to
poorer stability

(*) indicates the preferred method/duration of administration; some injections are not available in CGH # Reconstituted injections are recommended to be used within 24 hours 5
 CGH Dilution and Administration Guidelines Antibiotics
DRUG NAME POSSIBLE DILUENT(S) MAXIMUM APPROXIMATE MAXIMUM POSSIBLE ROUTE(S) OF INCOMPATIBILITIES/
(BRAND NAME) CONCENTRATION PERIOD OF PERIOD OF ADMINISTRATION SPECIAL PRECAUTIONS
References AFTER DILUTION STABILITY AT STABILITY AT
25C 4C#
Ceftriaxone IV - 10 mL WFI 100 mg/mL 6 hours 24 hours IV - Slow IV bolus injection over 3-5 Should not be mixed in the same
Inj 1 g minutes container with aminoglycoside
antibiotics as this will lead to
1,2 IV As above, followed by 40mg/mL 24 hours 72 hours IV - Intermittent IV infusion over 30 inactivation of the aminoglycoside
further dilution to 50 mL minutes (*)
with normal saline (*) Should not be mixed in the same
container with blood products,
IM 3.5 mL of lignocaine 1% 250 mg/mL 24 hours - IM Deep IM injection into gluteal protein hydrosylates or lipid
to reach a total volume or lateral thigh muscle. emulsions
of 4 mL
Maximum of 2 mL to be injected at
each site

Ceftriaxone IV - 10 mL WFI, followed by 40mg/mL 24 hours 72 hours IV - Intermittent IV infusion over 30

Inj 2 g further dilution to 50 mL minutes (*)
with normal saline (*)
1,2 DO NOT ADMINISTER AS IM OR
IV BOLUS

Cefuroxime IV 6 mL WFI, D5% or normal 120 mg/mL 5 hours 48 hours IV - Slow IV bolus injection over 3-5 Should not be mixed in the same
Inj 750 mg saline minutes container with aminoglycoside
(Zinacef) antibiotics as this will lead to
IV - As above, followed by 15 mg/mL 24 hours 72 hours IV - Intermittent IV injection over 30 inactivation of the aminoglycoside
1,2 further dilution to 50 mL minutes (*)
with normal saline Should not be mixed in the same
or D5% (*) Doses >1 g should not be given IV container with blood products,
(N.B. For doses of >1 g, dilute bolus protein hydrosylates or lipid
to final volume of 100 mL ) emulsions

IM - 3 mL WFI, shake gently to 220 mg/mL 5 hours 48 hours IM - Deep IM injection into gluteal
produce an opaque muscle or thigh muscle
suspension

(*) indicates the preferred method/duration of administration; some injections are not available in CGH # Reconstituted injections are recommended to be used within 24 hours 6
 CGH Dilution and Administration Guidelines Antibiotics
DRUG NAME POSSIBLE DILUENT(S) MAXIMUM APPROXIMATE MAXIMUM POSSIBLE ROUTE(S) OF INCOMPATIBILITIES/
(BRAND NAME) CONCENTRATION PERIOD OF PERIOD OF ADMINISTRATION SPECIAL PRECAUTIONS
References AFTER DILUTION STABILITY AT STABILITY AT
25C 4C#
Cefazolin Inj 1 g IV bolus Reconstitute with 160 mg/mL 24 hours 7 days IV - Slow IV bolus injection over 3-5 Should not be mixed in the same
10 mL WFI minutes container with aminoglycoside
1,2,5 Doses >1g should not be given IV antibiotics as this will lead to
bolus inactivation of the aminoglycoside

IV infusion - Reconstitute with 20 mg/mL 24 hours 7 days IV - Intermittent IV infusion over 20- Should not be mixed in the same
10 mL WFI, followed by 30 minutes (*) container with blood products,
further dilution to 100 mL with protein hydrosylates or lipid
normal saline or D5% (*) emulsions

IM - 3 mL of WFI 200 mg/mL 24 hours - IM - Deep IM injection into gluteal

muscle or thigh muscle

Chloramphenicol IM - 5 mL normal saline (*) 200 mg/mL 24 hours 24 hours IM - Deep IM injection into major Physically incompatible with
Inj 1 g muscle mass (*) aminophylline , -lactam
(Kemicetine) antibiotics, aminoglycosides,
IV - As above, followed by 10 mg/mL 24 hours 24 hours IV - Intermittent IV infusion over 30- macrolide antibiotics,
1 further dilution to 100 mL 60 minutes hydrocortisone sodium succinate,
with normal saline hydroxyzine, nitrofurantoin,
phenytoin sodium, promethazine,
tetracycline antibiotics,
vancomycin and vitamin B
complex

Cidofovir Inj IV - Withdraw the appropriate - 24 hours 24hours IV- administer over 1 hour Caution in handling. Cidofovir is
375 mg/5 ml dose and dilute to 100ml toxic and personnel should be
(Vistide) with N/S For I.V. infusion only adequately protected during
handling and administration; if
1,2,5 solution comes into contact with
skin or mucosa, wash off
immediately with water.

(*) indicates the preferred method/duration of administration; some injections are not available in CGH # Reconstituted injections are recommended to be used within 24 hours 7
 CGH Dilution and Administration Guidelines Antibiotics
DRUG NAME POSSIBLE DILUENT(S) MAXIMUM APPROXIMATE MAXIMUM POSSIBLE ROUTE(S) OF INCOMPATIBILITIES/
(BRAND NAME) CONCENTRATION PERIOD OF PERIOD OF ADMINISTRATION SPECIAL PRECAUTIONS
References AFTER DILUTION STABILITY AT STABILITY AT
25C 4C#
Ciprofloxacin Inj IV - Pre-reconstituted 2 mg/mL - - IV - Intermittent IV infusion over Infusion is a clear, colourless to
200 mg/100 mL 1 hour pale yellow solution

st
Clarithromycin IV - 10 mL WFI, followed by 2 mg/mL 6 hours 24 hours IV - Intermittent IV infusion over Avoid use in 1 trimester of
Inj 500 mg further dilution to 250 1 hour pregnancy
(Klacid) mL with normal saline or
WFI DO NOT ADMINISTER AS IM OR
1,2 IV BOLUS

Clindamycin IV - Further dilution to 50 mL
Inj 300 mg/2 mL with normal saline or
(Dalacin C) D5% (*)
(N.B. For higher doses, dilute
1,2 to multiples of 50 mL, i.e.,
300 mg - dilute to 50 mL
600 mg - dilute to 50 mL
900 mg - dilute to 50-100 mL
1200 mg - dilute to 100 mL
18mg/mL 24 hours 24 hours IV - Intermittent IV infusion (*) Should not be administered
concurrently with erythromycin
300 mg run over 10 minutes
600 mg - 20 minutes Physically incompatible with
900 mg - 30 minutes ampicillin, phenytoin sodium,
1200 mg - 40 minutes barbiturates, aminophylline,
calcium gluconate and
Rate should not exceed 30 mg/min magnesium sulphate
or more than 1200 mg/hr

IM - Pre-reconstituted 150 mg/mL - - IM - IM injection into abdomen,

female pelvis or area of
infection
Single IM dose should not exceed
600 mg

DO NOT ADMINISTER AS IV
BOLUS

(*) indicates the preferred method/duration of administration; some injections are not available in CGH # Reconstituted injections are recommended to be used within 24 hours 8
 CGH Dilution and Administration Guidelines Antibiotics
DRUG NAME POSSIBLE DILUENT(S) MAXIMUM APPROXIMATE MAXIMUM POSSIBLE ROUTE(S) OF INCOMPATIBILITIES/
(BRAND NAME) CONCENTRATION PERIOD OF PERIOD OF ADMINISTRATION SPECIAL PRECAUTIONS
References AFTER DILUTION STABILITY AT STABILITY AT
25C 4C#
Cloxacillin IV - 10 mL normal saline or 50 mg/mL - - IV - Slow IV bolus injection over 3-5 Solution for IM or IV bolus
Inj 500 mg WFI minutes injection should be used
immediately after preparation
3 IV - As above, followed by 20mg/mL 4 hours - IV - Intermittent IV infusion over 30-
further dilution to 100 mL 60 minutes (*) Should not be mixed in the same
with normal saline or container with aminoglycoside
D5% (*) antibiotics as this will lead to
inactivation of the aminoglycoside
IM - 2 mL WFI 250 mg/mL - - IM - Deep IM injection into major
muscle mass Should not be mixed in the same
container with blood products,
protein hydrosylates or lipid
emulsions
Colistimethate IV Dissolve in 50 mL normal 0.02 MU/mL To be used 24 hours IV Intermittent IV infusion over 30 Aerosol solution may appear
Sodium saline to form a clear immediately minutes slightly hazy and may foam if
Inj 1 MU solution shaken. Nebulization should take

(Colomycin ) 24 hours Inhalation Use via nebuliser place in a well-ventilated room
Inhalation - Dissolve each 0.5 MU/mL
1 1 MU with 2mL of
normal saline or
WFI and pour into
nebuliser

Co-trimoxazole Inj IV - Each 5 mL to be diluted With respect to 6 hrs125 mL Do NOT IV - Intermittent IV infusion over 1 Do not refrigerate as this may
(Trimethoprim 80 mg with 125-250 mL of trimethoprim: 2 hrs75 mL refrigerate hour cause precipitation of drug
/ Sulphamethoxazole normal saline (*) or D5%
400 mg in 5 mL) DO NOT ADMINISTER AS IM OR
(generic Bactrim) 5 mL - dilute to 125 mL 1.07 mg/mL IV BOLUS
10 mL - dilute to 250 mL (5 mL dilute to
1, 2, 3, 6 15 mL - dilute to 500 mL 75 mL of D5%)

Daptomycin IV 10 mL normal saline. 50 mg/mL 12 hours 48 hours IV- push over 2 minutes
To minimize foaming, avoid
Inj 500 mg Leave to stand for 10 min.
vigorous agitation or shaking of
(Cubicin) Gently rotate to dissolve IV- Intermittent IV infusion over 30
the vial during or after
powder. Withdraw minutes
reconstitution.
1,5 required amount of
reconstituted solution
Not compatible with dextrose-
containing diluents.
IV - Further dilute to 50 mL 10 mg/ml 12 hours 48 hours
with normal saline (*) Do not mix or co-infuse with any
other medications.

(*) indicates the preferred method/duration of administration; some injections are not available in CGH # Reconstituted injections are recommended to be used within 24 hours 9
 CGH Dilution and Administration Guidelines Antibiotics
DRUG NAME POSSIBLE DILUENT(S) MAXIMUM APPROXIMATE MAXIMUM POSSIBLE ROUTE(S) OF INCOMPATIBILITIES/
(BRAND NAME) CONCENTRATION PERIOD OF PERIOD OF ADMINISTRATION SPECIAL PRECAUTIONS
References AFTER DILUTION STABILITY AT STABILITY AT
25C 4C#
Doxycycline IV- Further dilute to 100 mL 1 mg/mL 24 hours 24 hours IV Intermittent IV infusion over 2 Not compatible with Lactated
Inj 100 mg/5 mL with normal saline or D5% hours Ringers solution
Protect from Protect from
1,5 light light

Ertapenem IV- 10 mL WFI or normal 20 mg/mL 6 hours 24 hours IV Intermittent IV infusion over 30 Should not be reconstituted or
Inj 1 g saline, followed by minutes (*) mixed with any solution containing
(Invanz) further dilution to 50 mL dextrose (e.g. D5%)
with normal saline (*)
1 Should not be mixed or co-infused
IM - Dilute in 3.2 mL of 1% 300 mg/mL 1 hour - IM - Deep IM injection into gluteal with other medications
lignocaine muscle or thigh muscle

Erythromycin IV - 10 mL WFI 50 mg/mL 24 hours 14 days Physically incompatible with

(Lactobionate) aminoglycoside antibiotics,
Inj 500 mg Followed by further dilution 10 mg/mL 8 hours - IV - Intermittent IV infusion over 20- tetracyclines, aminophylline
to 100-500 mL with normal 60 minutes (*)
1,2 saline (*) Do not use D5% as a diluent

IV - 10 mL WFI, followed by 1 mg/mL 8 hours - IV Continuous infusion

dilution to 500 mL with
normal saline

Flucloxacillin IV 20 mL WFI 120 mg/mL 24 hours 14 days IV Slow IV bolus injection over 3-5 Physically incompatible with
Inj 1 g minutes aminoglycoside antibiotics

2 IV As above, followed by 20 mg/mL - IV Intermittent IV infusion over 30 Should not be mixed with blood
further dilution to 50 mL minutes products or other proteinaceous
with normal saline fluids

IM 2.5 mL WFI 400 mg/mL - IM Deep IM injection into the

affected area

(*) indicates the preferred method/duration of administration; some injections are not available in CGH # Reconstituted injections are recommended to be used within 24 hours 10
 CGH Dilution and Administration Guidelines Antibiotics
DRUG NAME POSSIBLE DILUENT(S) MAXIMUM APPROXIMATE MAXIMUM POSSIBLE ROUTE(S) OF INCOMPATIBILITIES/
(BRAND NAME) CONCENTRATION PERIOD OF PERIOD OF ADMINISTRATION SPECIAL PRECAUTIONS
References AFTER DILUTION STABILITY AT STABILITY AT
25C 4C#
Fluconazole IV - Pre-reconstituted 2 mg/mL - - IV - Intermittent IV infusion over 1-2 Infusion rate must not exceed 200
Inj 100 mg/50 mL hours mg/hour (100 mL/hour)

1 For doses >200 mg, e.g., 400 mg,

run infusion over 2 hours

Foscarnet Sodium Inj To run over central line: 24 mg/mL 24 hours after Do NOT IV- Intermittent IV infusion over at Not compatible with solutions
24 mg/mL IV - Pre-reconstituted opening refrigerate least 1 hour containing calcium, dextrose 30%
[250 mL] (24 mg/mL) Maximum rate of 1 mg/kg/min solution, amphotericin B, acyclovir
(Foscavir) sodium, ganciclovir, pentamidine
To run via peripheral line 12 mg/mL 24 hours after IV- Continuous infusion over 24 isethionate, trimethoprim-
1 IV- Further dilute to 500 mL dilution hours sulphamethoxazole and
with normal saline or D5% (Start with intermittent IV infusion vancomycin hydrochloride
of 20 mg/kg body weight over
30min, followed by continuous IV Renal toxicity can be reduced by
infusion) adequate hydration of the patient.
It is recommended to add 2.5
DO NOT ADMINISTER AS IV litres over 24 hours when
BOLUS foscarnet is given as continuous
infusion and to add 0.5 - 1.0 litre
of normal saline to each infusion
when on intermittent therapy

Fusidate Sodium Inj IV - 10 mL of buffer solution 2 mg/mL 24 hours 7 days IV - Intermittent IV infusion over 3 Physically incompatible with
500 mg provided, followed by (if diluted in hours vancomycin, aminoglycoside
(Fucidin) further dilution to 250- D5%) antibiotics, -lactam antibiotics,
500 mL with normal DO NOT ADMINISTER AS IM, calcium-containing products,
1,2 saline or D5% (*) Subcut OR IV BOLUS blood products or protein
hydrosylates

Ganciclovir IV 10 mL WFI, shake to 50 mg/mL 12 hours - IV- Intermittent IV infusion over 1 Use caution in handling the vials
Inj 500 mg dissolve powder hour Avoid inhalation or direct contact
(Cymevene) of the powder or the reconstituted
Withdraw required dose and 10 mg/mL - 24 hours DO NOT ADMINISTER AS IM, solution. Ganciclovir is a potential
1 further dilute to 50-100 mL Subcut OR IV BOLUS teratogen and carcinogen.
with normal saline or D5%
Should not be mixed with other IV
products

(*) indicates the preferred method/duration of administration; some injections are not available in CGH # Reconstituted injections are recommended to be used within 24 hours 11
 CGH Dilution and Administration Guidelines Antibiotics
DRUG NAME POSSIBLE DILUENT(S) MAXIMUM APPROXIMATE MAXIMUM POSSIBLE ROUTE(S) OF INCOMPATIBILITIES/
(BRAND NAME) CONCENTRATION PERIOD OF PERIOD OF ADMINISTRATION SPECIAL PRECAUTIONS
References AFTER DILUTION STABILITY AT STABILITY AT
25C 4C#
Gentamicin IV - For doses up to 140 mg, 10 mg/mL 24 hours 24 hours IV Intermittent IV infusion over 30- Should not be mixed in the same
Inj 80 mg/2 mL further dilution to 50 mL 60 minutes (*) container as -lactam antibiotics
with normal saline (*) or (e.g. penicillin G, cloxacillin,
2, 5 D5% If given once daily, infuse over 60 cephazolin) as this will lead to
minutes inactivation of the aminoglycoside
For doses >140 mg, antibiotic
further dilution to 100 mL DO NOT ADMINISTER AS IV
BOLUS

IM Pre-reconstituted - - - IM - Deep IM injection into infected

area
Imipenem/ IV 10 mL normal saline or 5 mg/mL 4 hours 24 hours IV - Intermittent IV infusion over 20- Should not be reconstituted or
Cilastatin D5%. Further dilute to 30 minutes mixed with any solution containing
Inj 500 mg 100 mL with normal saline lactate
(Tienam) (*) or D5% For doses >500 mg, run infusion
over 60 minutes Should not be mixed with or
1 physically added to other
antibiotics

Decrease the rate of infusion if

patient develops nausea

Isoniazid IV Reconstitute with 10ml 5 mg/mL 24 hours 24hours IV Infuse over 1 hour
Inj 500 mg WFI

(Isozid 0,5N )
Further dilute to 100-250ml of
1 sodium chloride infusion

Levofloxacin Injection IV - Pre-reconstituted 5mg/ml Stable through Stable through IV-slow infusion over 60 minutes Never administer in the same IV
500 mg/100 ml or expiry date expiry date every 24 hours (250mg/500mg) or through the same tubing with
250 mg/50 ml any solution containing
(CRAVIT) IV-slow infusion over 90 minutes multivalent cations (e.g. calcium,
every 24 hours (750mg) magnesium).
1
DO NOT ADMINISTER AS IM,
Subcut OR IV BOLUS

(*) indicates the preferred method/duration of administration; some injections are not available in CGH # Reconstituted injections are recommended to be used within 24 hours 12
 CGH Dilution and Administration Guidelines Antibiotics
DRUG NAME POSSIBLE DILUENT(S) MAXIMUM APPROXIMATE MAXIMUM POSSIBLE ROUTE(S) OF INCOMPATIBILITIES/
(BRAND NAME) CONCENTRATION PERIOD OF PERIOD OF ADMINISTRATION SPECIAL PRECAUTIONS
References AFTER DILUTION STABILITY AT STABILITY AT
25C 4C#
Linezolid IV Pre-reconstituted 2 mg/mL - - IV - Intermittent IV infusion over 30- Keep infusion bags in foil
1,5
Inj 600 mg/300 mL 120mins overwrap and protect from light
(Zyvox) until ready to use
Chemically incompatible with
1 ceftriaxone sodium

Meropenem IV 10 mL WFI 50 mg/mL 8 hours 48 hours IV Slow IV bolus over 5 minutes Should not be mixed with or
Inj 500 mg added to other drugs
(Meronem) IV 10 mL WFI, followed by 20 mg/mL 8 hours 48 hours IV - Intermittent IV infusion over 30
further dilution to 50-100 minutes (*)
1 mL of normal saline

Metronidazole IV Pre-reconstituted 5 mg/mL - Do NOT IV Intermittent IV infusion over 1 Unused portions should be
Inj 500 mg/100 mL refrigerate hour discarded, not stored

1, 2, 5 , 6 Do not refrigerate as this may

cause precipitation of drug
Moxifloxacin IV Pre-reconstituted 1.6 mg/mL - Do NOT IV Intermittent IV infusion over 1 Do not store the infusion solution
Inj 400 mg/250 mL refrigerate hour in a refrigerator as precipitation
(Avelox) may occur
DO NOT ADMINISTER AS IV
1, 2, 5 BOLUS Do not run with sodium chloride
10% or 20%, or with sodium
bicarbonate solutions

Benzylpenicillin IV - 5 mL WFI 1 MU/mL - - IV - For doses <1 MU, slow IV bolus Should not be mixed in the same
(Crystalline Penicillin injection can be carried out container with aminoglycoside
G) Injection 5MU over 5-10 minutes antibiotics as this will lead to
inactivation of the aminoglycoside
1,2 IV As above, followed by 0.1 MU/mL 24 hours 72 hours IV Intermittent IV infusion over 30-
further dilution to 100 mL 120 minutes (*) Should not be mixed in the same
with normal saline or container with blood products,
D5% (*) Run larger doses > 2MU over protein hydrosylates or lipid
longer infusion times i.e. > 1hr emulsions

(*) indicates the preferred method/duration of administration; some injections are not available in CGH # Reconstituted injections are recommended to be used within 24 hours 13
 CGH Dilution and Administration Guidelines Antibiotics
DRUG NAME POSSIBLE DILUENT(S) MAXIMUM APPROXIMATE MAXIMUM POSSIBLE ROUTE(S) OF INCOMPATIBILITIES/
(BRAND NAME) CONCENTRATION PERIOD OF PERIOD OF ADMINISTRATION SPECIAL PRECAUTIONS
References AFTER DILUTION STABILITY AT STABILITY AT
25C 4C#
Pentamidine Inhalation 6 mL WFI - 48 hours - 1. Place reconstituted solution into Cough or bronchospasm during
Isethionate Protect from reservoir of Respigard II nebuliser inhalation can be controlled by
Inj 300 mg/vial light administration of a bronchodilator
2. Deliver the solution using an air via a separate nebuliser or MDI
1,2,5 flow of 5-7 L/min from a 40-50 PSI
air/oxygen source Pre-treatment with salbutamol
NUH PIVAS inhaler 5-10 min before inhalation
US CDC guidelines 3. Deliver until nebuliser is chamber may reduce coughing and
is empty. The process may take 30- bronchospasm
45 minutes
Pregnant women should avoid
4. Discard Respigard Nebuliser exposure to aerosolised
after each use pentamidine

IV - Dilute each 300mg or
fraction thereof in 3-5ml of
WFI or D5%
Subsequent dilution in 50-
250ml of normal saline or
D5%
100mg/ml 24hrs 48hrs Slow IV infusion over 60 minutes Direct IV bolus or rapid
(concentration with patient in a supine position (to administration must not be used.
100mg/ml & reduce incidence of severe
60mg/ml) hypotension). Sudden, severe hypotension may
occur following single IV dose.
Baseline BP should be
st
established before 1 dose and
monitored closely during
administration until stable.

Piperacillin/ IV - 20 mL of normal saline or 225 mg/mL 24 hours 24 hours IV Slow IV bolus over 3-5 minutes Administer aminoglycosides
Tazobactam WFI through separate lines
Inj 4.5 g
(Generic Tazocin) IV - As above, followed by 90 mg/mL 24 hours 24 hours IV Intermittent IV infusion over 30 Should not be mixed in the same
further dilution to 50 mL minutes (*) bag with blood products, sodium
1,2 with normal saline or D5% bicarbonate, or albumin
hydrosylates
Polymyxin B IV - Dissolve in 300-500 mL 1667 units/mL 24 hours 72 hours IV Intermittent IV infusion over 90 Neurotoxicity may be enhanced
Inj 500,000 units D5% (*) or normal saline minutes or continuous infusion by concurrent administration of
over 12 hours other neurotoxic drugs.
1 IM - 2 mL WFI, normal saline 250000 units/mL 24 hours 72 hours IM - Deep IM injection into major
or procaine HCl 1% muscle mass Neurotoxicity may result in
(IM route is not recommended respiratory paralysis from
due to severe pain at inj site) neuromuscular blockade
IT - 10 mL normal saline 50000 units/mL 24 hours 72 hours IT - Conventional Intrathecal
(N.B. Treatment of choice for injection
Ps. aeruginosa meningitis)

(*) indicates the preferred method/duration of administration; some injections are not available in CGH # Reconstituted injections are recommended to be used within 24 hours 14
 CGH Dilution and Administration Guidelines Antibiotics
DRUG NAME POSSIBLE DILUENT(S) MAXIMUM APPROXIMATE MAXIMUM POSSIBLE ROUTE(S) OF INCOMPATIBILITIES/
(BRAND NAME) CONCENTRATION PERIOD OF PERIOD OF ADMINISTRATION SPECIAL PRECAUTIONS
References AFTER DILUTION STABILITY AT STABILITY AT
25C 4C#

Procaine Penicillin IM Dilute in 5 mL WFI 0.375 MU/mL 6 hours 24 hours IM - Slow deep IM injection into The prepared suspension should
Inj 4 MU (N.B. Final reconstituted of procaine upper outer quadrant of gluteal be well shaken before use
(Fortepen) product is a suspension with a penicillin muscle using 18-20 gauge
final volume of 8 mL) needle. When repeating doses, vary the
1, NSC guidelines injection site
To give a 2.4 MU dose, draw out
6.5 mL Should not be administered in
dextrose solutions
NOT FOR IV OR Subcut USE

Quinine IV - Dilute required dose in 2mg/mL 24 hours - IV - For severe falciparum malaria
Dihydrochloride 300-1000 mL normal only; 20 mg/kg by slow IV
Inj 600 mg/2 mL saline or D5% infusion over 4 hours, followed
by 10 mg/kg infusion over 2-8
3 hours every 8 hours (*)

IV - For fast loading, 7 mg/kg

infusion over 30 minutes,
followed by 10 mg/kg over
4 hours

Streptomycin IM 4 mL WFI or normal 200 mg/mL 1 week - IM - Deep IM injection into buttocks, No preservatives present.
Inj 1 g saline (if protected thigh or deltoid muscle Recommend to use freshly
from light) prepared solutions
1 NOT FOR IV USE

Teicoplanin IV 3 mL of WFI (use diluent 100 mg/1.5 mL Used 24 hours IV - Slow IV bolus injection over 3-5 Unused portion should always be
Inj 200 mg provided). Gently roll vial immediately minutes refrigerated
(Targocid) until powder dissolves. If upon
solution is foamy, stand reconstitution Solutions of teicoplanin and
1,2 for 15 min before use aminoglycosides are incompatible
and should not be directly mixed
IV - As above, then further 4 mg/mL 24 hours - IV Intermittent IV infusion over 30 prior to injection
dilute to 100-200 mL with minutes (*)
normal saline or D5%

IM - 3 mL WFI 50 mg/mL - 24 hours IM - Deep IM injection into large

muscle mass

(*) indicates the preferred method/duration of administration; some injections are not available in CGH # Reconstituted injections are recommended to be used within 24 hours 15
 CGH Dilution and Administration Guidelines Antibiotics
DRUG NAME POSSIBLE DILUENT(S) MAXIMUM APPROXIMATE MAXIMUM POSSIBLE ROUTE(S) OF INCOMPATIBILITIES/
(BRAND NAME) CONCENTRATION PERIOD OF PERIOD OF ADMINISTRATION SPECIAL PRECAUTIONS
References AFTER DILUTION STABILITY AT STABILITY AT
25C 4C#
Tigecycline IV Each 50 mg vial to be 10 mg/mL IV Intermittent IV infusion over The reconstituted solution should
Inj 50 mg reconstituted with 5.3 mL 3060 minutes be yellow to orange in colour; if
(Tygacil) normal saline or D5% not, the solution should be
discarded.
1
Withdraw 5 mL (or 10 mL [100 1 mg/mL 6 hours 24 hours
mg dose] from 2 vials) of
reconstituted solution and
further dilute to 100 mL with
normal saline or D5%
Vancomycin IV - 10 mL WFI, followed by 5 mg/mL 24 hours 24 hours IV Intermittent IV infusion over at
Inj 500 mg further dilution to 100-500 least 2 hours
mL of normal saline or
1,2 D5% DO NOT ADMINISTER AS IM OR
IV BOLUS

Oral 10 mL WFI. Draw out
all the contents and
further dilute to 40 mL
with WFI.
Voriconazole IV- 19 mL WFI (to give final
Inj 200 mg volume of 20 mL). Draw
(Vfend) out required amount, and
further dilute to 100 mL
1,2 with normal saline or D5%
12.5 mg/mL - 24 hours Oral Consume the required dose Prepare a fresh mixture every day
e.g. 10 mL for 125 mg dose.
Remaining balance can be
stored in refrigerator and to
be used within 24 hours.
10 mg/mL Used 24 hours IV Intermittent IV infusion over 1-2 For patients with moderate to
immediately hours severe renal impairment, change
upon to oral voriconazole
5 mg/mL reconstitution Max infusion rate: 3 mg/kg/hr
Infusions of blood products must
DO NOT ADMINISTER AS IV not occur simultaneously with
BOLUS voriconazole

Incompatible with sodium

bicarbonate 4.2%

(*) indicates the preferred method/duration of administration; some injections are not available in CGH # Reconstituted injections are recommended to be used within 24 hours 16
CGH Dilution and Administration Guidelines Antibiotics

ADDITIVE COMPATIBILITY

Y -
Can antibiotic A be mixed together in the same infusion with antibiotic B?

YES, can be mixed (Compatible in both D5% & N/S unless otherwise stated; Metronidazole comes in a pre-mixed infusion)
ADDITIVE
Y* -
N
YES, but no clinical evidence; likely compatible based on past experience
No, do not mix
COMPATIBILITY
- Denotes information not available, should not mix together

General points:
- Mixed solutions should be used immediately or within 4 hours
(MIX TOGETHER)
- Always check for impurities, precipitates and colour changes before and during infusion.
- Compatibility data are specific for stated infusion fluids (N/S or D5%) at usual concentrations.
- Check with the pharmacist if additional info is required

(B) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Metronidazole
Ciprofloxacin

Clindamycin
Amoxicillin/

Vancomycin
Tazobactam
Piperacillin/
Clavulanate

Ceftazidime

Meropenem
Ceftriaxone

Penicillin G
Gentamicin
Cephazolin
Aztreonam

Cloxacillin

Imipenem/
Ampicillin

Cilastatin
(A)
Drug

Amoxicillin/
1 - - - - - N - - - - - N - - -
Clavulanate
2 Ampicillin - Y (N/S) Y4 (N/S) - - N4 Y (N/S) - N - - Y - - -
3 Aztreonam - Y (N/S) Y - - Y Y Y3 (D5%) Y - - N - - N
4 Cephazolin - Y4 (N/S) Y - - - Y - N2 - - Y Y3 - N2
5 Ceftazidime - - - - - Y Y - N2 - - Y - - N2
6 Ceftriaxone - - - - - - N - - - - Y - - N2
7 Ciprofloxacin N N4 Y - Y - N - Y - - Y - - -
8 Clindamycin - Y (N/S) Y Y Y N N - Y - - Y Y (D5%) - -
3 2
9 Cloxacillin - - Y (D5%) - - - - - N - - - Y* - -
10 Gentamicin - N Y N3 N3 - Y Y N3 - Y (N/S) Y N - -
11 Imipenem/ Cilastatin - - - - - - - - - - - - - - -
12 Meropenem - - - - - - - - - Y (N/S) - - - - Y (N/S)
13 Metronidazole N Y N Y Y Y Y Y - Y - - Y - -
3 3
14 Penicillin G - - - Y - - - Y (D5%) Y* N - - Y N N3
Piperacillin/
15 - - - - - - - - - - - - - N3 N3
Tazobactam
16 Vancomycin - - N N3 N3 N3 - - - - - Y (N/S) - N3 N3
Superscript denotes reference N/S = normal saline D5% = dextrose 5% in water

17
CGH Dilution and Administration Guidelines Antibiotics

Y-SITE COMPATIBILITY
Can antibiotic A be run together with antibiotic B through the same Y-site Y-SITE
Y- YES, can run together (Compatible in both D5% & N/S unless otherwise stated; Metronidazole comes in a pre-mixed infusion) COMPATIBILITY
Y* - YES but no clinical evidence; likely compatible based on past experience
N No, do not run together
- Denotes information not available, should not run together

General points:
(RUN TOGETHER)
- Always check for impurities, precipitates and colour changes before and during infusion.
- Compatibility data are specific for stated infusion fluids (N/S or D5%) at usual concentrations.
- Check with the pharmacist if additional info is required

(B) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Metronidazole
Ciprofloxacin

Clindamycin
Amoxicillin/

Vancomycin
Tazobactam
Piperacillin/
Clavulanate

Ceftazidime

Meropenem
Ceftriaxone

Penicillin G
Gentamicin
Cephazolin
Aztreonam

Cloxacillin

Imipenem/
Ampicillin

Cilastatin
(A) Drug

Amoxicillin/
1 - - - - - - - - - - - - - - -
Clavulanate
4 4
2 Ampicillin - Y (N/S) Y (N/S) - - N Y (N/S) - N - - Y - - Y (N/S)
3
3 Aztreonam - Y (N/S) Y Y (D5%) Y (D5%) Y Y Y (D5%) Y Y (D5%) - N - Y (D5%) Y
4 4 3
4 Cephazolin - Y (N/S) Y - - - Y - N - - Y Y - N3
N3
5 Ceftazidime - - Y (D5%) - - Y - - N - - Y - -

6 Ceftriaxone - - Y (D5%) - - - - - - - - Y - - N3
7 Ciprofloxacin - N4 Y - Y - - - Y - - Y - - -
8 Clindamycin - Y (N/S) Y Y Y - - - Y - - Y Y (D5%) Y (D5%) -
9 Cloxacillin - - Y3 (D5%) - - - - - N3 - - - Y* - -
4 3
10 Gentamicin - N Y N N - Y Y N - Y (N/S) Y N - -
11 Imipenem/ Cilastatin - - Y (D5%) - - - - - - - - - - -
12 Meropenem - - - - - - - - - Y (N/S) - - - - Y (N/S)
13 Metronidazole - Y N Y Y Y Y Y - Y - - Y Y (D5%) -
3 3
14 Penicillin G - - - Y - - - Y (D5%) Y* N - - Y N N3
Piperacillin/
15 - - Y (D5%) - - - - Y (D5%) - - - - Y (D5%) N3 N3
Tazobactam
16 Vancomycin - Y (N/S) Y N3 N3 N3 - - - - - Y (N/S) - N3 N3
Superscript denotes reference N/S = normal saline D5% = dextrose 5% in water

18
CGH Dilution and Administration Guidelines Antibiotics

References:
1. Product Information Leaflets
th
2. Trissel LA. Handbook on Injectable Drugs, 17 Ed, American Society of Health-System
Pharmacists, USA, 2013.
3. Drug monographs. In: Klasco RK (Ed): DRUGDEX System. Thomson MICROMEDEX,
Greenwood Village, Colorado
4. King Guide to Parenteral Admixtures
th
5. Gahart BL, Nazareno AR. Intravenous Medications 29 Ed, Mosby, Inc, USA, 2013.
st
6. Drug Information Handbook 2012-2013 (21 Edition)

CGH Drug Information Service

Original version was created in Apr 1998
Last updated on 28 June 2016

19