AmDPV7 PDF

Antimicrobial Dilution Protocol (AmDP)
This is a general guide for dilution of antimicrobial injections within

MOH facilities in Penang State. Users are advised to refer to the
current practice at the respective facilities and update accordingly.
Pharmaceutical Services Division

Penang State Health Department
Ministry Of Health Malaysia
i
ANTIMICROBIAL DILUTION PROTOCOL

First Edition 2016
This is a publication of Pharmaceutical Services Division, Penang State Health

Department. Enquiries are to be directed to the address below. Permission is hereby
granted to reproduce information contained herein provided that such reproduction
be given due acknowledgement and shall not modify the text.
This guideline can be downloaded from JKNPP website at

www.jknpenang.moh.gov.my
Pharmaceutical Services Division,

Penang State Health Department,
Aras 8, Bangunan Persekutuan,
Jalan Anson,
10400 Pulau Pinang,
Malaysia.
Tel: 04- 2292319
Fax: 04- 2280314
ii
ACKNOWLEDGEMENT
.
This guideline is an initiative by the Medication Safety Committee of Pharmaceutical
Services Division, Penang State HealthELEDGEMENT
Department.
The committee would like to express our heartfelt gratitude to Dato’ Dr. Sukumar Mahesan
(Director of Penang State Health Department), Puan Zubaidah Binti Che’ Embee (Deputy
Director Pharmacy of Penang State Health Department), members of reviewers, contributors
and all those involve for their valuable and constructive comments in the completion of this
guideline.
REVIEWERS
Dr. Wong Peng Shyan, Dr. Loo Lay Khoon,
Infectious Disease Consultant, Medical Specialist,
Medical Department, Hospital Pulau Pinang Medical Department, Hospital Seberang Jaya
Madam Sherene Tan Su Ann, Madam Chua Cheah Chin,

Pharmacist, Hospital Pulau Pinang Pharmacist, Hospital Kepala Batas
Madam Che Ropani Binti Talib, Madam Saparbee Binti Mohamad,

State Matron, Senior Matron, Hospital Seberang Jaya
Penang State Health Department
Madam Malathi D/O Govindasamy,

Medical Ward Matron, Hospital Pulau Pinang
iii
CONTRIBUTORS
Oiyammaal D/O Maruthan Chelliah Syazleen Binti Razak

Pharmacist, Hospital Pulau Pinang Pharmacist, Hospital Pulau Pinang
Subramaniam S/O Thanimalai Celine Choong Yen Ching

Pharmacist, Hospital Seberang Jaya Pharmacist, Hospital Bukit Mertajam
Nurul Ain’ Binti Satar Ong Chiou Ting

Pharmacist, Hospital Kepala Batas Pharmacist, Hospital Sungai Bakap
Nasira Binti Mohamed Ayub Tan Huey Yih

Pharmacist, Hospital Balik Pulau Pharmacist, PKD Timur Laut
Ng Wei Min Afida Amir Binti Ismet Amir Mohd. Idris

Pharmacist, PKD Barat Daya Pharmacist, PKD Seberang Perai Utara
Tan Yin Shan Nurzawani Binti Yusof

Pharmacist, PKD Seberang Perai Selatan Pharmacist, PKD Seberang Perai Tengah
Tan Pei Ling

Senior Assistant Director
Pharmacy Practice and Development Division
(Penang State)
EDITORS
Rohaizan Binti Mohd Hanafiah Lim Shiou Hui

Senior Principle Assistant Director Pharmacist, Hospital Pulau Pinang
Pharmacy Practice and Development Division
(Penang State)
Nasira Binti Mohamed Ayub

Pharmacist, Hospital Balik Pulau
iv
FOREWORD
DIRECTOR PENANG STATE HEALTH DEPARTMENT
The use of antimicrobial is very crucial in the treatment of infection and to prevent the
disease from spreading. Nevertheless, antimicrobial resistance in our country is at a
alarming level due to their frequent and widespread use in the health sector. Moreover,
the use of antimicrobial has been abused. Many strategies have been implemented
by Ministry of Health Malaysia to promote the appropriate use of antimicrobial and to
enhance the quality use of antimicrobial for optimum treatment outcome.
Consequently, this will control the spread of antimicrobial resistance.
Dilution of antimicrobial is one of the essential strategies to ensure the correct

reconstitution and dilution method of antimicrobial for effective, safe and optimum
result to the patient. The concentration of the final dilution of antimicrobial is important
to ensure the stability, quality and safety of the antimicrobial with minimal adverse drug
reactions. At the same time minimize the occurrence of medication errors of handling
antimicrobial in the wards.
This protocol is aim to give a quick , simple and comprehensive guide to all health care
providers especially those who handle reconstitution of antimicrobials in ward. It is a
guide to accurate and correct method in reconstitution or dilution of the antimicrobial
that is prescribed and at the same time minimize the occurrence of medication errors.
Finally, I would like to congratulate the committees who have contributed their time
and effort in establishing this protocol to ensure a safe and effective practice in Penang
state. I hope that this protocol will serve its purpose well in ensuring correct
reconstitution or dilution of antimicrobials and instilling safe medication handling in all
health care facilities in Penang state.
Thank you.
DATO’ DR. SUKUMAR MAHESAN

Director Penang State Health Department
v
FOREWORD
DEPUTY DIRECTOR (PHARMACY) OF PENANG

STATE HEALTH DEPARTMENT
Prompt antimicrobial therapy for an infection can make the difference between cure
and death or long-term disability. Unfortunately, the use and misuse of antimicrobials
has driven antimicrobial to resistance and led to a loss of efficacy of these “miracle
drugs”. Improving antimicrobial use decisions ultimately involves guiding treatment
decisions made by patients and healthcare providers and ensure the infected patients
have access to quality medicines.
Errors in reconstitution and dilution of antimicrobial are medication errors that reported
in our health care facilities. These errors will affect the patients’ treatment outcome,
increase the general health care cost and promote antimicrobial resistance. In order
to minimize this medication error, Pharmaceutical Services Division, Penang State
Health Department takes the initiative to establish a comprehensive and quick protocol
as a guide for all healthcare providers during the process of reconstitution or dilution
of antimicrobials that are available in our health care facilities.
All antimicrobials listed in this protocol are available in Malaysia market and our health
care facilities. This protocol will be useful in facilitating the health care providers in the
wards for correct reconstitution or dilution of antimicrobials. This list may be updated
from time to time if there is any new antimicrobial available in the market and edited
at the individual health care facilities.
Finally, I would like to express my appreciation to all the members in working

committee, editors and reviewers for their great effort and time in establishing this
protocol.
Thank you.
Deputy Director (Pharmacy) Of Penang State Health Department
vi
TABLE OF CONTENTS
PAGES
1. INTRODUCTION………………………………………………………………………………. 1
2. ABOUT AmDP………………………………………………………………………………….. 2
3. GUIDE IN USING AmDP……………………………………………………………………….. 3
4. GENERAL INFROMATION…………………………………………………………………….. 4
5. ANTIMICROBIAL DILUTION PROTOCOL
5.1 Acyclovir Inj………………………………………………………………………….. 5-8
5.2 Anidulafungin Inj…………………………………………………………………….. 9
` 5.3 Amikacin Inj………………………………………………………………………….. 10 - 11
5.4 Amoxycillin/ Clavulanate Inj………………………………………………………… 12 - 14
5.5 Ampicilin Inj………………………………………………………………………….. 15 - 17
5.6 Ampicillin/ Sulbactam Inj……………………………………………………………. 18 - 19
5.7 Amphotericin B Inj…………………………………………………………………… 20
5.8 Artesunate Inj………………………………………………………………………… 21
5.9 Azithromycin Inj……………………………………………………………………… 22
5.10 Benzathine Penicillin Inj…………………………………………………………….. 23
5.11 Benzylpenicillin Inj…………………………………………………………………… 24 - 25
5.12 Caspofungin Inj……………………………………………………………………… 26
5.13 Cefazolin Inj………………………………………………………………………….. 27
5.14 Cefepime Inj………………………………………………………………………….. 28 - 32
5.15 Cefotaxime Inj……………………………………………………………………….. 33 – 36
5.16 Cefoperazone Inj…………………………………………………………………….. 37
5.17 Cefoperazone/ Sulbactam Inj………………………………………………………. 38 – 40
5.18 Ceftaroline Inj………………………………………………………………………… 41
5.19 Ceftazidime Inj……………………………………………………………………….. 42 – 43
5.20 Ceftriaxone Inj……………………………………………………………………….. 44 – 45
5.21 Cefuroxime Inj……………………………………………………………………….. 46 – 47
5.22 Ciprofloxacin Inj……………………………………………………………………… 48 – 49
5.23 Clindamycin Inj………………………………………………………………………. 50 – 51
5.24 Cloxacillin Inj…………………………………………………………………………. 52
5.25 Doripenem Inj………………………………………………………………………... 53
5.26 Ertapenem Inj………………………………………………………………………... 54
5.27 Erythromycin Inj……………………………………………………………………… 55
5.28 Fluconazole Inj………………………………………………………………………. 56
5.29 Gentamicin Inj……………………………………………………………………….. 57
5.30 Imipenem/ Cilastatin Inj…………………………………………………………….. 58
5.31 Kanamycin Inj………………………………………………………………………... 59
5.32 Levofloxacin Inj………………………………………………………………………. 60 - 62
5.33 Linezolid Inj…………………………………………………………………………... 63
5.34 Meropenem Inj………………………………………………………………………. 64 – 67
5.35 Metronidazole Inj…………………………………………………………………….. 68
5.36 Moxifloxacin Inj………………………………………………………………………. 69
5.37 Netilmycin Inj………………………………………………………………………… 70 – 71
5.38 Pentamidine Inj………………………………………………………………………. 72
vii
TABLE OF CONTENTS
PAGES
5.39 Piperacillin/ Tazobactam Inj……………………………………………………….. 73 – 76

5.40 Polymyxin B Inj……………………………………………………………………….. 77
5.41 Streptomycin Inj………………………………………………………………………. 78 - 80
5.42 Sulfamethoxazole/ Trimethoprim Inj……………………………………………….. 81
5.43 Vancomycin Inj……………………………………………………………………….. 82 – 83
5.44 Voriconazole Inj………………………………………………………………………. 84 – 85
5.45 Zidovudine Inj…………………………………………………………………………. 86
6. NON FORMULARY DILUTION PROTOCOL
6.1 Daptomycin Inj………………………………………………………………………… 87
6.2 Liposomal Amphotericin B Inj………………………………………………………... 88
6.3 Micafungin Sodium Inj………………………………………………………………… 89
6.4 Colistimethate Sodium (Polymyxcin E) Inj………………………………………….. 90
6.5 Tigecyclin Inj ………………………………………………………………………….. 91
6.6 Pentamidine Isothionate Inj………………………………………………………….. 92
6.7 Quinine Dihydrochloride Inj…………………………………………………………... 93
7. ABBREVIATION…………………………………………………………………………………. 94
8. REFERENCES……………………………………………………………………………………. 95 – 97
viii
INTRODUCTION
Intravenous therapy is the most important form of treatment in hospitalized

patients. It is essential to achieve desired plasma drug levels fast so that these patients
could obtain immediate therapeutic effect. Hence, intravenous antimicrobials provide
quick onset of action that safe patients’ life and minimize complication due to infection.
Contrary, these injectables can cause serious harm, not effective and lead to
antimicrobial resistant if prepared and given wrongly. For example, administration
intravenous Vancomycin in less than 60 minutes can cause “Red Man Syndrome”.
Study of Injectable Medication Errors done by American Nurses Association

revealed that 99% of nurses believed medication errors related to injectable
medication can cause serious harm to patient. Errors that occurred during preparation
and administration these medications accounted for 48% of the total error. Therefore,
a guide on dilution and administration of injectable medication serves as a proper
education that promotes safer medication practice at the healthcare facilities.
Reference:
Medication Errors and Syringe Safety Are Top Concerns for Nurses According to
New National Study [press release].
http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressRele
ases/2007/
1
ABOUT ANTIMICROBIAL DILUTION PROTOCOL (AmDP)
 Serves as a drug reference for Adult cases ONLY. Clinical

discretion is necessary tailoring to patient condition and
practice preference.
 Included antibiotics, antivirals and antifungals injection listed in

Ministry of Health Formulary (Year 2015) and Non-formulary
Antimicrobial (KPK drug) available at health facilities in Penang
State.
 All drugs available in Malaysia are listed with their brand names.
Healthcare providers may find the details according to brand name
if there is a change in brand.
 Most of the information is based on brand and manufacturer

recommendation. Thus, may subject to change.
 Drugs are listed alphabetical in orders and subclass according to

brand name.
 Information might be the same for different brands. Thus there will
be more than one brand listed in one table. Example; brand Azee®
and Zitromax® for Azithromycin Injection.
2
GUIDE IN USING AmDP
1. Check the generic name of antimicrobial injection.
2. Check the brand name of antimicrobial injection.
3. Search page number of generic and brand name at content page.
4. Read all information in the table before reconstitute or dilute the

drugs.
5. If the drug or the brand is not listed in the protocol, contact

Pharmacy Department in respective healthcare facility for further
information.
3
GENERAL INFORMATION
1. All preparations should be done using aseptic technique.112

2. Do NOT freeze medications.111
3. Do NOT use the initial concentrate or the infusion solution if there is any sign
of precipitation and presence of foreign matter in either one.111
4. Kindly refer to pharmacist if the medication changes in color upon
reconstitution unless stated otherwise in product insert.111
5. Do NOT mix other drugs to the infusion solution to avoid any possible drug
interactions.111
6. Any unused portion should be discarded after the recommended period of
use.111
7. For multiple use vials, reconstituted solution must be labelled with time and
date immediately after preparation112 and must be placed under
recommended storage condition.
8. Flush IV line with NS before and after administration.112
9. In general, slow intravenous injection is to be given over 3 – 5 minutes;
intravenous infusion over 30 - 60 minutes113 unless stated otherwise in
product insert.
 This general information may not be applicable to all the medications

available. Please consult your pharmacist for further information.
References:
111. Intravenous Drugs Preparation & Administration Quick Reference, Medical Department &
Pharmacy Department Kuala Lumpur Hospital, 2011
112. John D & Rebecca L, 2010. Guide to the Safe Preparation and Administration of Intravenous (IV)
Antibiotics at Home. http://www.newcastle-
hospitals.org.uk/downloads/cardiothoracic/Patient_info_-_safe_prep_and_admin_of_IV_ab.pdf
113. Dilution Protocol 2010, Hospital Selayang 2 nd
4
1.0 ACYCLOVIR INJECTION
1.1 BRAND : Zovirax ®
STRENGTH 250mg Powder
IV :
Reconstitute with 10ml WFI/ NS
RECONSTITUTION/ Further dilute with:

DILUTION
Dose To be diluted with
250mg – 500mg 100 ml NS
500mg – 1gm 200 ml NS
ADMINISTRATION Slow IV infusion over 1 hour
After Reconstitution After Dilution

RT RT
STABILITY
Used immediately after
12 hours
reconstitution
DO NOT REFRIGERATE
INCOMPATIBILITY -
REMARKS -
Reference :
1. PRODUCT LEAFLET : Zovirax For Infusion 250mg, GlaxoSmithKline.
5
1.2 BRAND : Medovir ®
STRENGTH 250mg powder
IV:
Reconstitute
Dose Notes
250mg Reconstitute with 5ml NS/ WFI
RECONSTITUTION/
500mg Reconstitute with 10ml NS/ WFI
DILUTION
Further dilute with NS to give concentration not greater than

5mg/ml (minimum volume can be diluted 100ml of NS to
achieve concentration ≤ 5mg/ml)
ADMINISTRATION IV infusion over at least 1 hour

RT RT
STABILITY 12 hours
reconstitution
DO NOT REFRIGERATE
Biological or colloidal solutions

INCOMPATIBILITY (blood products, protein containing solutions), Parabens
-
REMARKS
Reference :
2. PRODUCT LEAFLET : Medovir 250mg Injectible, Medochemie.
6
1.3 BRAND : DBL Acyclovir Intravenous Infusion ®
STRENGTH 250mg Powder
IV :
Reconstitute
Dose Notes
RECONSTITUTION/ 250mg Reconstitute with 10ml NS/ WFI
DILUTION 500mg Reconstitute with 20ml NS/ WFI
Further dilute with NS to give concentration not greater than

5mg/ml (minimum volume can be diluted 100ml of NS to
achieve concentration ≤ 5mg/ml)
ADMINISTRATION IV infusion only, to be given over a period at least 1 hour

RT RT
STABILITY 12 hours
reconstitution
DO NOT REFRIGERATE
-
INCOMPATIBILITY
-
REMARKS
Reference :
3. PRODUCT LEAFLET : DBL Acyclovir Hospira.
7
1.4 BRAND : Vaxcel Acyclovir ®
STRENGTH 250mg in 10ml
IV :
Dilute 250mg with 50ml NS/ D5
RECONSTITUTION/
Dilute 500mg with 100ml NS/ D5
DILUTION
- concentration not greater than 5mg/ml
IV :
ADMINISTRATION
Infuse over 1 hour by controlled infusion pump
To be diluted immediately before use.
After Dilution
STABILITY RT
24 hours
Solution should not be refrigerated.

-
INCOMPATIBILITY
For intravenous infusion over at least 1 hour to prevent renal
REMARKS tubular damage
Reference :
4. PRODUCT LEAFLET: Vaxcel Acyclovir Kontra Pharma.
8
2.0 ANIDULAFUNGIN INJECTION
2.1 BRAND : Eraxis ®
IV:
RECONSTITUTION/ For 100mg: Reconstitute with 30ml WFI
DILUTION Further dilute with 100ml NS/ D5
For 200mg: Reconstitute with 60ml WFI

Further dilute with 200ml NS/ D5
IV:
Rate of infusion: Should not exceed 1.1mg/min
(equivalent 1.4 ml/min for both 100mg and 200mg doses)
ADMINISTRATION
Dose Minimum Duration of Infusion
100mg 90 minutes
200mg 180 minutes
STABILITY
-This medication must be kept in fridge at 2 - 8°C

RT 2 - 8°C RT 2 - 8°C
24 hours NA 48 hours NA
INCOMPATIBILITY -
REMARKS -
Reference :
5. PRODUCT LEAFLET : Eraxis, Pfizer.
9
3.0 AMIKACIN INJECTION
3.1 BRAND : Apalin ®
IM:
Inject directly
RECONSTITUTION/
DILUTION
IV infusion:
Add to 100 to 200ml NS/ D5
(Maximum concentration: 5mg/ml)
IM
ADMINISTRATION
IV Infusion over 30 - 60 minute period
At concentration of 0.25mg/ml and 5mg/ml

STABILITY RT 2 - 8°C RT 4°C -15°C
(frozen)
Information not available 24 60 days 30 days
(recommend to use hours
immediately)
-
INCOMPATIBILITY
Solutions may vary in color from colorless to light straw or

REMARKS
very pale yellow. Discard dark-colored solutions
Reference :
6. PRODUCT LEAFLET : Apalin, CCM Duopharma Bio Tech.
10
3.0 AMIKACIN INJECTION
3.2 BRAND : Selemycin ®
STRENGTH 500ml in 2ml
IM:
Inject directly
RECONSTITUTION/
DILUTION IV Infusion:
Add into 100 - 200ml NS/ D5
ADMINISTRATION IV infusion over 30 - 60 minutes
At concentration of 0.25mg/ml and 5mg/ml

STABILITY RT 2 - 8°C RT 4°C
Information not 24 hours 60 days
available (recommend
to use immediately)
INCOMPATIBILITY -
REMARKS Do not freeze
Reference :
7. PRODUCT LEAFLET : Selemycin Medochemie Ltd, Cyprus.
11
4.0 AMOXYCILLIN/ CLAVULANATE INJECTION
4.1 BRAND : Augmentin Intravenous ®
600mg powder
STRENGTH
1.2g powder
Slow IV injection:
i) 600mg vial: Reconstitute with 10ml WFI
(Final Volume 10.5ml)
ii) 1.2g vial: Reconstitute with 20ml WFI
(Final Volume 20.9ml)
RECONSTITUTION/
DILUTION IV infusion:
i) 600mg vial: Reconstitute with10ml WFI
Further dilute with 50ml WFI/ NS
ii) 1.2g vial: Reconstitute with 20ml WFI

Slow IV bolus over 3 – 4 minutes

ADMINISTRATION
IV infusion over 30 - 40 minutes

STABILITY RT 2 - 8°C RT
20 minutes - 4 hours
REFREGIRATED RECONSTITUTED SOLUTION MUST
IMMEDIATELY USED ONCE REACHING ROOM TEMPERATURE
Should not be mixed with blood products, proteinaceous fluids (e.g.
protein hydrolysates and or IV lipid emulsions
INCOMPATIBILITY
Should not be administered concurrently with aminoglycosides in
syringe, IV fluid container or giving set as it may cause loss of
aminoglycosides activity
It is less stable in infusion containing glucose, dextran or

REMARKS
bicarbonate (Do not add to such solutions)
Reference :
8. PRODUCT LEAFLET : Augmentin Intravenous GlaxoSmithKline
12
4.2 BRAND : Clamentin Injection ®
STRENGTH 1.2g powder
IV:
Add 20ml of WFI
RECONSTITUTION/
Add 20ml of WFI
Further dilute to 100ml WFI/ NS
Slow IV bolus over 3 - 4 minutes

ADMINISTRATION
IV Infusion over 30 - 40 minutes
If use WFI as diluent:-

RT 2 - 8°C RT
10 minutes - 4 hours
STABILITY
If use NS as diluent:
-
RT 2 - 8°C RT
- - 4 hours
Should not be mixed with blood products, proteinaceous

fluids (e.g. protein hydrolysates and or IV lipid emulsions
INCOMPATIBILITY
Should not be administered concurrently with
aminoglycosides in syringe, IV fluid container or giving set as
it may cause loss of aminoglycosides activity

REMARKS
Appearance: White to off white powder in vial. Solution will be
a colorless to pale yellow liquid in vial without other foreign
matter
Reference :
9. PRODUCT LEAFLET : Clamentin Injection, Yung Shin Pharmaceutical Ind. Co., Ltd.
13
4.3 BRAND : Co-Amoxiclav Injection ®
IV :
Add 20ml of WFI
RECONSTITUTION/
DILUTION IV infusion:
Add 20ml of WFI

ADMINISTRATION
STABILITY Information not available (recommend to use immediately)

Should not be mixed with blood products, proteinaceous fluids
(e.g. protein hydrolysates and or IV lipid emulsions)
INCOMPATIBILITY Should not be administered concurrently with aminoglycosides

in syringe, IV fluid container or giving set as it may cause loss of
aminoglycosides activity

REMARKS
Appearance: Sterile Powder for injection
A transient pink coloration may appear during reconstitution.
Upon completion may appear colorless or pale straw color
Reference :
10. PRODUCT LEAFLET : Co-Amoxiclav Injection Averroes Pharmaceuticals Sdn Bhd.
14
5.0 AMPICILIN INJECTION
5.1 Ampicillin Sodium for Injection BP ®
IM:
Reconstitute with 1.5ml of WFI
RECONSTITUTION/
DILUTION
IV:
Reconstitute with 10ml of WFI
IM
ADMINISTRATION
Not to be administer concurrently with beta-lactam

antibacterials and aminoglycosides.
INCOMPATIBILITY
If administered concurrently, separate sites at least 1
hour.
REMARKS -
Reference :
11. PRODUCT LEAFLET : Ampicillin Sodium for Injection B, Karnataka Antibiotics &
Pharmaceuticals Limited, India; July 2009.
15
5.0 AMPICILLIN INJECTION
5.2 BRAND : Pamecil®
IM:
RECONSTITUTION/
DILUTION
IV:
Reconstitute with 5ml of WFI (for 500 mg dose)
Reconstitute with 7.4ml of WFI (for 1 g dose)
IM
ADMINISTRATION Slow IV bolus over 3 – 5 minutes (for 250 – 500 mg

dose)
Slow IV bolus over 10 – 15 minutes (for 1 g dose)
STABILITY Use immediately after reconstitution.
INCOMPATIBILITY -
REMARKS -
Reference :
12. PRODUCT LEAFLET : Pamecil, Medochemie Ltd, Selangor.
16
5.0 AMPICILLIN INJECTION
5.3 BRAND : Standacillin ®
IM:
RECONSTITUTION/
Reconstitute with 5ml of WFI,
Further dilute with 50 - 500ml of NS
IM
ADMINISTRATION Slow IV bolus over 3 - 5 minutes

INCOMPATIBILITY -
REMARKS -
Reference :
13. PRODUCT LEAFLET : Standacillin, Sandoz.
17
6.0 AMPICILLIN/ SULBACTAM INJECTION
6.1 BRAND : Ampicillin & Sulbactam powder for injection ®
IV/ IM:
Reconstitute with 3.2 ml WFI
RECONSTITUTION/
DILUTION
IV Infusion:
Further dilute to 50 – 500 ml of NS
IM: Deep IM injection
ADMINISTRATION Slow IV Bolus over 3 - 4 minutes
INCOMPATIBILITY -
REMARKS -
Reference :
14. PRODUCT LEAFLET : Ampicillin & Sulbactam powder for injection Karnataka
Antibiotics & Pharmaceuticals Limited, India; August 2010.
18
6.0 AMPICILLIN/ SULBACTAM INJECTION
6.2 BRAND : Sulbacin ®
IM:
IV :
RECONSTITUTION/
DILUTION
IV Infusion:
Reconstitute with 5ml of WFI,
further dilute with 50 - 100ml NS
IM: Deep IM injection
ADMINISTRATION Slow IV bolus over 10 -15 minutes

RT 4°C Information not available
STABILITY
(recommend to use
8 hours 72 hours immediately)
INCOMPATIBILITY -
REMARKS -
Reference :
15. PRODUCT LEAFLET : Sulbacin, Unichem.
19
7.0 AMPHOTERICIN B INJECTION
7.1 BRAND : Amphotret ®
IV:
Reconstitute with 10ml of WFI ,
RECONSTITUTION/ Further dilute with 500ml D5 ( dose <50mg) or
DILUTION 1000ml (for dose > 50mg)
Maximum concentration of 0.1mg/ml
ADMINISTRATION Slow infusion over 2 - 6 hours

STABILITY
RT 2 - 8°C Use immediately after
24 hours 7days dilution
INCOMPATIBILITY -
If test dose is needed:
Test dose: 1mg (0.2ml) further dilute in 20ml of D5,

administer over 20-30 minutes
1. Monitor patient’s temperature, pulse, respiration rate &

blood pressure every 30 minutes for 2 - 4hours
REMARKS 2. Infusion related immediate reaction may happen with

chills, fever, hypotension, nausea or anaphylactic
reaction. Premedication (Paracetamol, Hydrocortisone/
Chlorpheniramine) given 30 minutes prior to
administration
3. Prophylactic antipyretics or hydrocortisone should only

be used in patients who have previously experienced
acute adverse reactions
References :
16. PRODUCT LEAFLET : Amphotret Bharat Serums And Vaccines Ltd.

99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,
Greenwood Village, Colorado, USA.
20
8.0 ARTESUNATE INJECTION
8.1 BRAND : Artesun ®
IM:
Reconstitute with 1ml of 5% sodium bicarbonate
solution,
Further dilute with 2 ml of NS/ D5
RECONSTITUTION/
DILUTION
IV:
Reconstitute with 1ml of 5% sodium bicarbonate
solution,
Further dilute with 5ml of NS/ D5
IM
ADMINISTRATION
Slow IV bolus (3 - 4 ml/min)
Information not available (recommend to use

STABILITY
immediately)
INCOMPATIBILITY -
REMARKS -
Reference :
17. PRODUCT LEAFLET : Artesun, Guilin Pharmaceutical Co Ltd.
21
9.0 AZITHROMYCIN INJECTION
9.1 BRAND : Azee ®

9.2 BRAND : Zitromax ®
(Brands above have same information)
IV:
RECONSTITUTION/
DILUTION
Further dilute with 250 - 500ml of NS/D5
IV infusion 1mg/ml over 3 hrs (500ml infusion)

ADMINISTRATION
IV infusion 2mg/ml over 1 hr (250ml infusion)

RT 2 - 8°C RT 2 - 8°C
Information not 24 hours 7 Days
STABILITY available (recommend (only for brand
to use immediately) Zithromax®)
INCOMPATIBILITY -
REMARKS -
References :
18. PRODUCT LEAFLET : Azee, Cipla United.

19. PRODUCT LEAFLET : Zitromax, Pfizer.
105. Injectable Drugs Dilution 2010, Bahagian Perkhidmatan Farmasi Perak.
106. Guidelines on Reconstitution & Administration of Injectable Drugs. 2013, Hospital
Kuala Lipis.
22
10.0 BENZATHINE PENICILLIN INJECTION
10.1 BRAND : Retarpen ®
RECONSTITUTION/
DILUTION
ADMINISTRATION IM only
STABILITY Use immediately after reconstitution
INCOMPATIBILITY -
REMARKS -
References :
20. PRODUCT LEAFLET : Retarpen, Sandoz.

100. MIMS Online; http://online1.mimsgateway.com.my.
Kuala Lipis.
23
11.0 BENZYLPENICILLIN INJECTION
11.1 BRAND : Penicilin G Sodium Sandoz ®
One million unit powder (600mg)

STRENGTH Five million unit powder (3g)
IM :
Reconstitute with 5 - 10ml WFI
(apply to not more than 6g of dose)
RECONSTITUTION/
DILUTION
IV injection/IV Infusion :
600mg vial: Reconstitute with 10ml WFI
3g vial: Reconstitute with 50ml of WFI
IM : Up to 5ml of injectable solution per injection site

ADMINISTRATION
IV : Information not provided
Use immediately after reconstitution and preparation
STABILITY
Penicillin G rapidly disintegrate even at refrigerated
temperature
Solutions contain metal ions, oxidating and reducing

substances, alcohol, glycerol, macrogols and other
INCOMPATIBILITY
hydroxyl compounds. Sympathomimetic amines,
Dextrose, Tetracycline
Ringer’s lactate or other solutions containing sodium

REMARKS should not be used to avoid electrolyte imbalance to
reconstitute the solution
Reference :
52. PRODUCT LEAFLET : Penicilin G Sodium Sandoz, Sandoz GmbH
24
11.0 BENZYLPENICILLIN INJECTION
11.2 BRAND : Benzyl Penicillin For Injection ®
One million unit powder (600mg)

STRENGTH Five million unit powder (3g)
600mg vial: Reconstitute with 2ml or more of WFI

RECONSTITUTION/
DILUTION
3g vial: Reconstitute with 10ml or more of WFI
IM : Up to 5ml of injectable solution
ADMINISTRATION
IV infusion: over 1 hour (1ml/min)

STABILITY
RT 2 - 8°C RT 2 - 8°C
2 days 6 days - -
Solutions contain metal ions should be administered

separately
INCOMPATIBILITY Should not be administered in the same syringe / giving

set as Amphotericin B, Cimetidine, Cytarabine,
Flucloxacillin, Hydroxyzine, Methylprednisolone or
Promethazine
REMARKS
-
Reference :
53. PRODUCT LEAFLET : Benzyl Penicillin For Injection, Karnataka Antibiotics &
Pharmaceuticals Ltd.
25
12.0 CASPOFUNGIN INJECTION
12.1 BRAND : Cancidas ®
50mg powder
STRENGTH
70mg powder
Let refrigerated Caspofungin to room temperature before

reconstitution.
RECONSTITUTION/ Reconstitute with 10.8 ml of NS or WFI

DILUTION i) For 70mg (loading dose): Withdraw two separate 5 ml
solution and add to two separate 100ml NS
ii) For 50mg : Take 10ml solution and dilute in 100ml NS
i) For 70mg (loading dose): Infuse first IV bag for 30

minutes followed by second IV bag for another 30 minutes
ADMINISTRATION
ii) For 50mg :Slow IV infusion over 1 hour

STABILITY RT 2 - 8°C RT 2 - 8°C
1 hour - 24 hours 48 hours
INCOMPATIBILITY Diluents containing dextrose

Dilution of 70mg in single 100ml IV bag not recommended
REMARKS
Final concentration should not exceed 0.5mg/ml
References :
22. PRODUCT LEAFLET : Cancidas, Merck Sharp & Dohme.

26
13.0 CEFAZOLIN INJECTION
13.1 BRAND : Cefazolin Sandoz ®

13.2 BRAND : Reflin ®
(Brands above have same information))
STRENGTH 1g powder
IM:
RECONSTITUTION/ IV:
DILUTION Reconstitute with 4ml WFI/ NS
IV infusion:
Further dilute with 50 – 100ml NS
Dose ≤ 1g: IM or slow infusion over 3 - 5 minutes
ADMINISTRATION
Dose > 1g: Infusion over 20 - 30 minutes

RT 2 - 8°C RT 2 - 8°C
STABILITY - 24 hours Information not available
(recommend to use
immediately)
-
INCOMPATIBILITY
REMARKS -
References :
23. PRODUCT LEAFLET : Cefazolin Sandoz.

24. PRODUCT LEAFLET : Reflin, Ranbaxy.
27
14.0 CEFEPIME INJECTION
14.1 BRAND : Verapime ®
STRENGTH 1g powder
IM :
Reconstitute with 3ml of WFI or 1% Lidocaine
RECONSTITUTION /
DILUTION IV:
Reconstitute with 10ml of NS/ D5
Further dilute to 50 -100ml with NS/ D5
IM
IV infusion over 30 minutes

RT 2 - 8°C RT 2 - 8°C
STABILITY
12 hours 24 hours Information not available
(recommend to use
immediately)
Should not administered concurrently with Ampicillin

(<40mg/mL), Aminophylline, Gentamicin, Metronidazole,
INCOMPATIBILITY Netilmicin, Tobramycin or Vancomycin
If administer concurrently, should use separate site
REMARKS -
References :
25. PRODUCT LEAFLET : Verapime, Demo S.A Pharmaceutical Industry.

101. Drug Information Handbook. 23rd ed. Vol. 2014-2015: Hudson, Ohio, Lexi-Comp, Inc.
28
14.2 BRAND : Vaxcel Cefepime ®
STRENGTH 1g powder
IM :
i) 500mg injection : Reconstitute with 1.5ml of WFI/ NS/ D5
ii)1g injection : Reconstitute with 3ml of WFI/ NS/ D5
RECONSTITUTION /
DILUTION IV :
i) 500mg injection : Reconstitute with 5ml of WFI /NS/ D5
ii) 1g injection : Reconstitute with 10ml of WFI/ NS/ D5
Further dilute to 50 - 100ml with WFI/ NS/ D5
IM

STABILITY
RT 2 - 8°C RT 2 - 8°C
24 hours 7 days 24 hours 7 days
Should not administered concurrently with Ampicillin (< 40mg/mL),

Aminophylline, Gentamicin, Metronidazole, Netilmicin, Tobramycin
INCOMPATIBILITY or Vancomycin
REMARKS -
References :
26. PRODUCT LEAFLET : Vaxcel Cefepime Kotra Pharma (M) Sdn. Bhd.
29
14.3 BRAND : Forpar ®
STRENGTH 1g powder
IM :
Reconstitute with 2.4ml of NS/ D5
RECONSTITUTION /
DILUTION IV :
Further dilute to 50 - 100ml with NS
IM

STABILITY
RT 2 - 8°C RT 2 - 8°C

(< 40mg/mL), Aminophylline, Gentamicin, Metronidazole,
REMARKS -
Reference :
27. PRODUCT LEAFLET : Forpar, Cipla (M) Sdn. Bhd. 2014.
30
14.4 BRAND : Megapime ®
500mg powder
STRENGTH
1g powder
IM :
i) 500mg : Reconstitute with 1.5ml of NS/ D5
ii)1g : Reconstitute with 3ml of NS/ D5
RECONSTITUTION /
DILUTION IV :
i) 500mg : Reconstitute with 5ml of NS/ D5
ii)1g : Reconstitute with 10ml of NS/ D5
Further dilute to 50 -100ml with NS/ D5
IM
IV infusion over approximately 30 minutes

STABILITY
RT 2 - 8°C RT 2 - 8°C

Concomitant administration with Probenecid prolongs

REMARKS renal tubular secretion of Cefepime, resulting high serum
concentration
Reference :
28. PRODUCT LEAFLET : Megapime, Alkem Lab Ltd. 2006.
31
14.5 BRAND : Sefepim ®
STRENGTH 1g powder
IM :
Reconstitute 1g with 3ml of NS/ D5
RECONSTITUTION /
DILUTION IV :
Reconstitute 1g with 10ml of NS/ D5
Further dilute with 50-100ml NS/ D5
IM
IV infusion over approximately 30 minutes

STABILITY
RT 2 - 8°C RT 2 - 8°C

INCOMPATIBILITY
Netilmicin, Tobramycin or Vancomycin. If administer
concurrently, should use separate site
IV route is preferable for severe/ life-threatening

REMARKS
infection, particularly if shock is present
Reference :
29. PRODUCT LEAFLET : Sefepim, Hovid Sdn Bhd. 2014.
32
15.0 CEFOTAXIME INJECTION
15.1 BRAND : Rekaxime ®
500mg powder
STRENGTH
1g powder
IM :
i) 500mg : Reconstitute with 2ml of WFI
ii)1g : Reconstitute with 4ml of WFI
IV :
RECONSTITUTION /
DILUTION
ii)1g : Reconstitute with 4ml of WFI
iii)2g : Reconstitute with 10ml of WFI
Short infusion : Further dilute with 2g in 40ml of NS/ D10

Continuous drip : Further dilute 2g vial in 100ml of NS/ D10
IM
ADMINISTRATION
Infusion
Short infusion over 20 minutes
Continuous drip over 50 - 60 minutes
STABILITY To be used immediately

INCOMPATIBILITY -
REMARKS/* If daily dose exceeds 2g, IV injection is preferred
Reference :
30. PRODUCT LEAFLET : Rekaxime, Duopharma (M) Sdn Bhd. 2011.
33
15.2 BRAND : Claraxim ®
500mg powder
STRENGTH
1g powder
IM :
1g : Reconstitute with 4ml of WFI
(Can further dilute with 4ml of 1% Lidocaine to avoid
pain)
IV
RECONSTITUTION /
i) 250mg & 500mg : Reconstitute with 2ml of WFI
DILUTION
ii) 1g : Reconstitute with 4ml of WFI
iii) 2g : Reconstitute with 10ml of WFI
Short infusion: further dilute 2g in 40ml of NS/ D10
Continuous drip: further dilute 2g in 100ml of NS/ D10
IM

ADMINISTRATION
Infusion
Short infusion over 20 minutes

RT 2 - 8°C RT 2 - 8°C
STABILITY
- 24 hours Information not available
(recommend to use
immediately)
INCOMPATIBILITY -
If daily dose exceeds 2g or Claraxim 1g is administered more

REMARKS
than twice daily, IV injection is preferred
Reference :
31. PRODUCT LEAFLET : Claraxim, Siam Bheasach Co. Ltd. 2006.
34
15.3 BRAND : Claforan ®
500mg powder
STRENGTH
1g powder
IM :
Further dilute with corresponding amount* of 1%
Lidocaine
IV :
RECONSTITUTION /
DILUTION
iii)2g : Reconstitute with 10ml of WFI
IM

ADMINISTRATION
Infusion
Short infusion over approximately 20 minutes

STABILITY
RT 2 - 8°C RT 2 - 8°C
12 hours 24 hours 12 hours 24 hours
-
INCOMPATIBILITY
Intravenous injection is recommended if the daily dose

REMARKS exceeds 2 g or if Claforan 1 g is administered more than
twice daily
* Suitable volume of Lidocaine to avoid pain during IM injection
Reference :
32. PRODUCT LEAFLET : Claforan, Aventis Pharma.
35
15.4 BRAND : Vaxcel Cefotaxime ®
500mg powder
STRENGTH
1g powder
IM :
Further dilute with corresponding amount* of 1% Lidocaine
IV :
RECONSTITUTION /
i) 1g : Reconstitute with 4ml of WFI
DILUTION

IM

ADMINISTRATION
IV Infusion
Short infusion over approximately 20 minutes

24 hours - Information not available
(recommend to use
immediately)
INCOMPATIBILITY -
Intravenous injection is recommended if the daily dose exceeds
REMARKS
2g or if Cefotaxime 1g is administered more than twice daily
* Suitable volume of Lidocaine to avoid pain during IM injection
Reference :
33. PRODUCT LEAFLET : Vaxcel Cefotaxime, Kotra Pharma (M) Sdn.Bhd.
36
16.0 CEFOPERAZONE INJECTION
16.1 BRAND : Bicafar ®

16.2 BRAND : Vaxcel Cefoperazone ®
500mg powder
STRENGTH 1g powder
2g powder
IM
i) 500mg : Reconstitute with 1.3ml of WFI
ii) 1g : Reconstitute with 2.6ml of WFI
iii) 2g : Reconstitute with 5.2ml of WFI
Further dilute
i) 500mg : add 0.4ml of 2% Lidocaine
RECONSTITUTION/ ii) 1g : add 0.9ml of 2% Lidocaine
DILUTION iii) 2g : add 1.8ml of 2% Lidocaine
Slow IV Bolus
dilute with WFI/NS/D5, final concentration 100mg/ml
IV
1g & 2g : Reconstitute with 5ml of WFI/ NS/ D5
Further dilute with 20 -100ml of WFI/ NS/ D5
IM
ADMINISTRATION Slow IV bolus over 3 - 5 minutes.
INCOMPATIBILITY -
REMARKS -
References :
34. PRODUCT LEAFLET : Bicafar, Duopharma (M) Sdn Bhd. 2012.

35. PRODUCT LEAFLET : Vaxcel Cefoperazone, Kotra Pharma (M) Sdn.Bhd.
37
17.0 CEFOPERAZONE/ SULBACTAM INJECTION
17.1 BRAND : Vaxcel Cefobactam ®
STRENGTH 1g powder
IV :
RECONSTITUTION/
1g : Reconstitute with 3.4ml of NS/ D5/ WFI
DILUTION
Further dilute with 20ml NS/ D5/ WFI
Slow IV bolus over of 3 minutes

ADMINISTRATION
IV Infusion: over 15 - 60 minutes
Dilute in D5 : Use immediately

Information not available
24 hours NA (recommend to use
immediately)
Should not be directly mixed with aminoglycoside due to

INCOMPATIBILITY
physical incompatibility.
REMARKS -
Reference :
36. PRODUCT LEAFLET : Vaxcel Cefobactam, Kotra Pharma (M) Sdn.Bhd.
38
17.2 BRAND : Cefper ®
STRENGTH 1g powder
IV :
RECONSTITUTION/
1g : Reconstitute with WFI to volume of 4ml
DILUTION
Further dilute to 20ml with WFI
Slow IV bolus over 3 minutes
ADMINISTRATION

RT 2 - 8°C RT 2 - 8°C
STABILITY 24 hours 5 days Information not available
(recommend to use
immediately)
INCOMPATIBILITY -
REMARKS -
Reference :
37. PRODUCT LEAFLET : Cefper Biolab Co. LTD, 2009.
39
17.3 BRAND : Cefoperazone & Sulbactam 1.0g
STRENGTH 1g powder
IV :
RECONSTITUTION/
1g : Reconstitute with 3.4ml of NS/ D5/ WFI
DILUTION
Further dilute with 20ml NS/ D5/ WFI
Slow IV bolus over of 3 minutes
ADMINISTRATION
INCOMPATIBILITY -
REMARKS -
Reference :
38. PRODUCT LEAFLET : Cefoperazone & Sulbactam 1.0G, Karnataka Antibiotics &
Pharmaceuticals Limited, 2010.
40
18.0 CEFTAROLINE INJECTION
18.1 BRAND : Zinforo ®

IV :
RECONSTITUTION/
DILUTION
Further dilute with 50ml - 250ml NS/ D5
ADMINISTRATION Infusion over 1 hour

RT 2 - 8°C RT 2 - 8°C
STABILITY
Use NA 6 hours 24 hours
immediately
INCOMPATIBILITY -
REMARKS Protect from light
Reference :
39. PRODUCT LEAFLET : Zinforo, Facta Farmaceutici S.p.A, October 2012.
41
19.0 CEFTAZIDIME INJECTION
19.1 BRAND : Cefatum ®
1g powder
STRENGTH
2g powder
IM :
Reconstitute with 3ml of 0.5% lignocaine HCl
RECONSTITUTION/ IV :
DILUTION Reconstitute with 10ml of WFI
IV infusion :
Further dilute with 50 - 500ml NS/ D5
IM

RT 2 - 8°C RT 2 - 8°C
STABILITY
WFI- 12 hours WFI- 7 days 12 hours 7 days
0.5% Lignocaine 0.5% Lignocaine
HCl- 6 hours HCl- 4 days
INCOMPATIBILITY -
REMARKS -
Reference :
40. PRODUCT LEAFLET : Cefatum, Duopharma (M) Sdn Bhd, 6 August 2010.
42
19.0 CEFTAZIDIME INJECTION
19.2 BRAND : Fortum ®
1g powder
STRENGTH
2g powder
IM :
Reconstitute with 3ml of 0.5% lignocaine HCl
RECONSTITUTION/
DILUTION IV :
IM
INCOMPATIBILITY -
REMARKS -
References :
41. PRODUCT LEAFLET : Fortum, GlaxoSmithKline.

43
20.0 CEFTRIAXONE INJECTION
20.1 BRAND : Unocef ®
250mg powder
1g powder
IM :
250mg: Reconstitute with 0.9ml of WFI/ NS/ D5
1g : Reconstitute with 3.6ml of WFI/ NS/ D5
RECONSTITUTION/
IV infusion :
DILUTION
250mg: Reconstitute with 2.4ml of WFI
500mg: Reconstitute with 4.8ml of WFI
1g : Reconstitute with 9.6ml of WFI

ADMINISTRATION IV infusion over 30 minutes
i) For IM :
Diluent Concentration After reconstitution
(mg/ml) RT 2 - 8°C
WFI 100 3 days 10 days
250, 350 24 hours 3 days

NS 100 3 days 10 days
250, 350 24 hours 3 days

STABILITY
D5 100 3 days 10 days
250, 350 24 hours 3 days
ii) For IV :
RT 2 - 8°C RT 2 - 8°C
3 days 10 days 3 days 10 days
INCOMPATIBILITY -
-
REMARKS
Reference :
42. PRODUCT LEAFLET : Unocef, Duopharma (M) Sdn Bhd, 27 July 2010.
44
20.0 CEFTRIAXONE INJECTION
20.2 BRAND : Rocephin ®
250mg powder
1g powder
IM :
1g : Reconstitute with 3.6ml of WFI/ NS/ D5
RECONSTITUTION/
IV infusion :
DILUTION
500mg:Reconstitute with 4.8ml of WFI
1g : Reconstitute with 9.6ml of WFI
STABILITY i) For IM :
Diluent Concentration Storage
(mg/ml) RT 2 - 8°C
WFI 100 2 days 10 days
250, 350 24 hours 3 days

NS 100 2 days 10 days
250, 350 24 hours 3 days

D5 100 2 days 10 days
250, 350 24 hours 3 days
ii) For IV :
RT 2 - 8°C RT 2 - 8°C
2 days 10 days 2 days 10 days
INCOMPATIBILITY -
REMARKS -
Reference :
43. PRODUCT LEAFLET : Rocephin, Roche.
45
21.0 CEFUROXIME INJECTION
21.1 BRAND : Zinacef ®
750mg powder
STRENGTH
1.5g powder
IM :
750mg : Reconstitute with 3ml of WFI
DILUTION 750mg: Reconstitute with 6ml of WFI
1.5g : Reconstitute with 15ml of WFI
Further dilute with 50 -100ml NS/ D5
IM

RT 2 - 8°C RT 2 - 8°C
STABILITY
(recommend to use
immediately)
INCOMPATIBILITY -
REMARKS -
References :
44. PRODUCT LEAFLET : Zinacef, GlaxoSmithKline.

46
21.0 CEFUROXIME INJECTION
21.2 BRAND : Anikef ®
750mg powder
STRENGTH
1.5g powder
IM :
RECONSTITUTION/
DILUTION
IV :
1.5g : Reconstitute with 15-50ml of WFI
IM

RT 2 - 8°C RT 2 - 8°C
STABILITY
(recommend to use
immediately)
INCOMPATIBILITY -
REMARKS -
Reference :
45. PRODUCT LEAFLET : Anikef Duopharma (M) Sdn Bhd, 2 September 2013.
47
22.0 CIPROFLOXACIN INJECTION
22.1 BRAND : Ciproxol ®
RECONSTITUTION/
Ready to use solution
DILUTION

STABILITY Remaining solution should be discarded.
INCOMPATIBILITY -
Protect from light
REMARKS
Do not refrigerate
Reference :
46. PRODUCT LEAFLET : Ciproxol Ain Medicare Sdn. Bhd.
48
22.0 CIPROFLOXACIN INJECTION
22.2 BRAND : Ciprobay ®

22.3 BRAND : Ufexil ®
RECONSTITUTION/
DILUTION
STABILITY Remaining solution should be discarded.
INCOMPATIBILITY Heparin, penicillins
Inspect for particulate matters and discoloration prior to

REMARKS administration. Only clear and colourless or slightly yellow
solution can be used
References :
47. PRODUCT LEAFLET : Ciprobay, Bayer Co. (Malaysia) Sdn Bhd.

48. PRODUCT LEAFLET : Ufexil DEMO S.A.
49
23.0 CLINDAMYCIN INJECTION
23.1 BRAND : Dalacin C ®
IM :
Inject directly
IV infusion :
RECONSTITUTION/
Final diluted concentration must be ≤18mg/ml
DILUTION
i) 300mg : Reconstitute with 50ml NS
ii) 600mg : Reconstitute with 100ml NS
iii) 900mg : Reconstitute with 150ml NS
iv) 1200mg: Reconstitute with 200ml NS
IM : ONLY for dose ≤600mg
IV Infusion :
ADMINISTRATION i) Dose of 300mg : over 10 minutes
ii) Dose of 600mg : over 20 minutes
iii) Dose of 900mg : over 30 minutes
iv) Dose of 1200mg: over 45 minutes
Ampicillin, Phenytoin Sodium, Diphenyldantoin, Barbiturates,

INCOMPATIBILITY Aminophylline, Calcium Gluconate, Magnesium Sulphate,
Ceftriaxone Sodium and Ciprofloxacin
REMARKS -
Reference :
49. PRODUCT LEAFLET : Dalacin C, Pfizer Inc.
50
23.0 CLINDAMYCIN INJECTION
23.2 BRAND : Tidact ®
IM :
Inject directly
IV infusion :
RECONSTITUTION/
Final diluted concentration must be ≤18mg/ml
DILUTION
i) Dose of 300mg : Reconstitute with 50ml NS.
ii) Dose of 600mg : Reconstitute with 100ml NS.
iii) Dose of 900mg : Reconstitute with 150ml NS.
iv) Dose of 1200mg: Reconstitute with 200ml NS.
IM : ONLY for dose ≤600mg
IV Infusion :
i) Dose of 300mg : over 10 minutes.
ADMINISTRATION
ii) Dose of 600mg : over 20 minutes.
iii) Dose of 900mg : over 30 minutes.
iv) Dose of 1200mg: over 45 minutes.
Maximum Rate: <30mg/min
-
INCOMPATIBILITY
REMARKS Avoid refrigerate
Reference :
50. PRODUCT LEAFLET : Tidact, Yung Shin Pharmaceutical Ind. Co., Ltd.
51
24.0 CLOXACILLIN INJECTION
24.1 BRAND : Cloxacillin Sodium ®
250mg powder
STRENGTH
500mg powder
IM :
250mg : Reconstitute with 1.9ml WFI
500mg : Reconstitute with 1.7ml WFI
IV Slow bolus :
250mg : Add 4.9ml WFI
500mg : Add 4.8ml WFI
RECONSTITUTION/
IV Infusion :
DILUTION
Reconstitute with 5ml WFI
Further dilute with 125ml to 250ml of NS
Continuous infusion :
Further dilute with 250ml NS (Dose ≤ 500mg) or 500ml NS
(Dose > 500mg)
Recommended concentration: 2mg/ml.
IM

ADMINISTRATION
IV infusion: 60 minutes
Continuous IV Infusion : 6 -12 hours

STABILITY
RT 2 - 8°C RT 2 - 8°C
24 hours - - -
Beta lactamase antibacterials, aminoglycosides. They should

INCOMPATIBILITY
be administered in separate sites at least 1 hour apart
REMARKS -
Reference :
51. PRODUCT LEAFLET : Cloxacillin Sodium, Karnataka Antibiotics & Pharmaceuticals

Ltd.
52
25.0 DORIPENEM INJECTION
25.1 BRAND : Doribax ®
IV :
RECONSTITUTION/
Reconstitute with 10ml WFI / NS
DILUTION
Further dilute with 100ml NS/ D5
ADMINISTRATION IV infusion over 1 hour

1 hour - 12 hours (NS) 72 hours (NS)
4 hours (D5) 24 hours (D5)
INCOMPATIBILITY -
REMARKS -
References:
54. PRODUCT LEAFLET : Doribax, Shionogi & Company Ltd.

53
26.0 ERTAPENEM INJECTION
26.1 BRAND : Invanz ®
IM :
Reconstitute with 3.2ml of 2% Lignocaine HCl Injection
RECONSTITUTION/
DILUTION IV :
Reconstitute with 10ml NS
Further dilute with 50ml NS
IM : Deep IM
ADMINISTRATION

RT 2 - 8°C RT 2 - 8°C
STABILITY
Information not available 6 hours 24 hours
(recommend to use
immediately)
INCOMPATIBILITY Do not use diluents containing dextrose

REMARKS -
Reference :
55. PRODUCT LEAFLET : Invanz, Laboratories Merck Sharp & Dohme-Chibret.
54
27.0 ERYTHROMYCIN INJECTION
27.1 BRAND : Erythromycin 500mg Injection
500mg powder
STRENGTH
IV :
RECONSTITUTION/ Reconstitute with 10 ml WFI
DILUTION Further dilute with 100 - 500 ml of NS/ D5 to a concentration of
1-5 mg/ml
ADMINISTRATION Intermittent infusion over 20 - 60 minutes
STABILITY Information not available (Use immediately after reconstitution)

-
INCOMPATIBILITY
REMARKS Bolus injection is not recommended
References :
56. PRODUCT LEAFLET : Erythromycin 500mg Injection Fisiopharma S.r.L.

55
28.0 FLUCONAZOLE INJECTION
28.1 BRAND : Diflucan ®

RECONSTITUTION/
DILUTION
IV infusion over 1 - 2 hour

ADMINISTRATION
(Maximum rate 200mg/ hour)
STABILITY Single use. Discard any unused portion
INCOMPATIBILITY -
REMARKS -
Reference :
57. PRODUCT LEAFLET : Diflucan, Pfizer.
56
29.0 GENTAMICIN INJECTION
29.1 BRAND : Garasent ®
IM/ IV:
Inject directly without further dilution
RECONSTITUTION/
DILUTION IV infusion :
Further dilute with 100 – 200 ml of NS/D5
(Maximum concentration: 1 mg/ ml)
IM
INCOMPATIBILITY -
REMARKS -
Reference :
58. PRODUCT LEAFLET : Garasent, Duopharma (M) Sdn Bhd.
57
30.0 IMIPENEM + CILASTATIN INJECTION
30.1 BRAND : Tienem ®
STRENGTH 500mg Imipenem & 500mg Cilastatin powder
IV :
RECONSTITUTION/
Reconstitute with 10 ml of NS/ D5
DILUTION
Further dilute to 100 ml of NS/ D5
IV:
ADMINISTRATION Dose imipenem ≤ 500 mg: over 20 – 30 minutes
Dose imipenem > 500 mg: over 40 – 60 minutes

RT 2 - 8°C RT 2 - 8°C
STABILITY
(recommend to use
immediately)
INCOMPATIBILITY -
REMARKS -
Reference :
59. PRODUCT LEAFLET : Tienem Merck Sharp & Dohme.
58
31.0 KANAMYCIN INJECTION
31.1 BRAND : Kanamycin Sulphate Injection Meiji

31.2 BRAND : Kanamycin Injection Yung Shin
31.3 BRAND : Kancin-L ®
STRENGTH 1g in 3ml
RECONSTITUTION/
Inject directly
DILUTION
ADMINISTRATION IM

-
INCOMPATIBILITY
REMARKS -
References :
60. PRODUCT LEAFLET : Kanamycin sulfate injection meiji, Thai Meiji Pharmaceutical
Co., Ltd.
61. PRODUCT LEAFLET : Kanamycin injection “Yung Shin”, Yung Shin Pharmaceutical
Ind. Co., Ltd.
62. PRODUCT LEAFLET : Kancin-L, Altantic Laboratories Corporation Ltd.
59
32.0 LEVOFLOXACIN INJECTION
32.1 BRAND : Cravit ®
RECONSTITUTION/
Ready to use solution.
DILUTION
IV Infusion :
ADMINISTRATION
Slowly over a period of not less than 60 - 90 minutes
Samples containing visible particles should be discarded.

STABILITY To be used within 3 hours of opening (rubber stopper
perforation)
There is no data concerning interaction but quinolones

INCOMPATIBILITY should not be co-administered with any solution containing
multivalent cations (e.g. magnesium), through the same line.
Avoid rapid or bolus IV infusion (may lead to hypotension)
REMARKS
(Appearance : Sterile, clear, greenish-yellow isotonic
solution)
References :
63. PRODUCT LEAFLET : Cravit, Daiichi Sankyo.

60
32.2 BRAND : Levofloxol ®
RECONSTITUTION/
Ready to use infusion solution
DILUTION
IV infusion over a period of not less than 60 or 90 minutes,

depending on the dosage.
ADMINISTRATION
The recommended infusion time at least:
- 30 minutes for 250 mg
- 60 minutes for 500mg
STABILITY Use immediately
LEVOFLOXOL should not mixed with heparin or alkaline

INCOMPATIBILITY
solutions (eg: sodium hydrogen carbonate)
REMARKS Rapid or bolus IV must be avoided
Reference :
64. PRODUCT LEAFLET : Levofloxol Ain Medicare Sdn. Bhd.
61
32.3 BRAND : Glevo I.V ®
IV :
250mg dose
Dilute with NS/ D5 to final volume 50ml
RECONSTITUTION/
500mg dose
DILUTION
750mg dose
Infuse over at least:

ADMINISTRATION
Dilution in NS/ D5:
STABILITY After Reconstitution After Dilution

RT 2 - 8°C RT 2 - 8°C
- - 72 hours 14 days
Not to be mixed with certain other solutions

INCOMPATIBILITY
( e.g. Sodium Hydrogen Carbonate) or with heparin
REMARKS Rapid or bolus IV must be avoided
References :
65. PRODUCT LEAFLET : Glevo I.V Glenmark Pharma.

99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health
Analytics, Greenwood Village, Colorado, USA.
62
33.0 LINEZOLID INJECTION
33.1 BRAND : Zyvox ®
RECONSTITUTION/ Withdraw required dose without further dilution

DILUTION
ADMINISTRATION IV Infusion over 30 - 120 minutes
All drugs below must be avoided in co-administration with

Linezolid in Y-site:
- Amphotericin B
- Chlorpromazine HCl
- Diazepam
INCOMPATIBILITY
- Pentamidine Isothionate
- Phenytoin Sodium
- Erythromycin Lactobionate
- Trimethoprim-sulfamethoxazole
- Protect from light

REMARKS - Do not use this infusion bag in series connections
- Additives should not be introduced into this solution
References :
66. PRODUCT LEAFLET : Zyvox Pfizer Inc.

63
34.0 MEROPENEM INJECTION
34.1 BRAND : Meronem ®
500mg powder
STRENGTH
1g powder
IV :
i) 500mg : Reconstitute with 10ml WFI
RECONSTITUTION/
ii)1 : Reconstitute with 20ml WFI
DILUTION
Further dilute with 50 - 500ml NS/D5
ADMINISTRATION Infusion over 15 - 30 minutes
If diluted in D5 : Use it immediately
STABILITY After Reconstitution After Dilution

RT 2 - 8°C RT 2 - 8°C
3 hours 12 hours 3 hours (NS) 24 hours (NS)
INCOMPATIBILITY -
REMARKS -
Reference :
67. PRODUCT LEAFLET : Meronem, AstraZeneca.
64
34.2 BRAND : DBL Meropenem ®
500mg powder
STRENGTH
1g powder
IV :
RECONSTITUTION/
ii)1g : Reconstitute with 20ml WFI
DILUTION
Slow IV bolus over 5 minutes for reconstituted solution

ADMINISTRATION
Infusion over 15 - 30 minutes

RT 2 - 8°C RT 2 - 8°C
STABILITY
8 hours 24 hours 8 hours (NS) 24 hours(NS)
(WFI) (WFI) 3 hours (D5) 14 hours (D5)
INCOMPATIBILITY -
REMARKS -
Reference :
68. PRODUCT LEAFLET : DBL TM Meropenem Hospira NZ Limited.
65
34.3 BRAND : Monem ®
500mg powder
STRENGTH
1g powder
IV :
RECONSTITUTION/
DILUTION
Further dilute with 50 - 500ml NS/D5
Slow IV bolus over 3 - 5 minutes for reconstituted solution

ADMINISTRATION

RT 2 - 8°C RT 2 - 8°C
STABILITY
2 hours 12 hours 2 hours (NS) 18 hours(NS)
(WFI) (WFI) 1 hours (D5) 8 hours (D5)
Incompatible with drug containing solution of :

(avoid the combination of both drugs in Y-site)
- Acyclovir sodium
- Calcium gluconate
INCOMPATIBILITY
- Diazepam
- Doxycycline hyclate
- Ondansetron
REMARKS -
References :
69. PRODUCT LEAFLET : Monem, Biolab.

66
34.4 BRAND : Meraparon ®
500mg powder
STRENGTH
1g powder
IV :
RECONSTITUTION/
DILUTION
Slow IV bolus over 5 minutes for reconstituted solution

ADMINISTRATION
STABILITY Use immediately
INCOMPATIBILITY -
REMARKS -
Reference :
70. PRODUCT LEAFLET : Meraparon, Novartis Corporation.
67
35.0 METRONIDAZOLE INJECTION
35.1 BRAND : Metronidazole 500mg Injection

35.2 BRAND : Metronol ®
35.3 BRAND : Metrogyl ®
RECONSTITUTION/
Infuse directly according the dose needed
DILUTION
ADMINISTRATION

-
INCOMPATIBILITY
REMARKS -
References :
71. PRODUCT LEAFLET : Metronidazole, B. Braun Medical Industries Sdn. Bhd.

72. PRODUCT LEAFLET : Metronol Ain Medicare Sdn. Bhd.
73. PRODUCT LEAFLET : Metrogyl, Unique Pharmaceutical Laboratories.
68
36.0 MOXIFLOXACIN INJECTION
36.1 BRAND : Avelox ®
RECONSTITUTION/ Infuse directly according to the dose needed

DILUTION If necessary , further dilute with the NS/D5
ADMINISTRATION Infusion over 60 minutes
Do not refrigerate – product precipitates upon refrigeration

STABILITY
Diluted solution stable over 24 hours at room temperature
INCOMPATIBILITY -
REMARKS Only clear solutions are to be used
References :
74. PRODUCT LEAFLET : Avelox, Bayer Schering Pharma AG, Germany.

69
37.0 NETILMYCIN INJECTION
37.1 BRAND : Lotifar ®
100mg in 2ml
STRENGTH
150mg in 2ml
DILUTION Dilute with 50 - 200ml NS /D5
IM: inject directly
ADMINISTRATION Infusion over 1½ to 2 hours (preferable)

Do not freeze
After Dilution
STABILITY RT 2 - 8°C
1 week at concentration of Information not available
3mg/ml (recommend to use
immediately)
-
INCOMPATIBILITY
Dark yellow solutions should not be used
LOTIFAR 100 MG/2 ML INJECTION is a clear, pale straw

REMARKS coloured solution
LOTIFAR 150 MG/2 ML INJECTION is a clear, colourless

to pale yellow solution
References :
75. PRODUCT LEAFLET : Lotifar, Duopharma (M) Sdn Bhd.

70
37.0 NETILMYCIN INJECTION
37.2 BRAND : Nelin ®
100mg in 2ml
STRENGTH
150mg in 1.5ml
DILUTION Dilute with 50 - 200ml NS / D5
IM: inject directly
ADMINISTRATION Infusion over 1½ to 2 hours
After Dilution
RT 2 - 8°C
Use immediately Information not available
STABILITY (recommend to use
immediately)
Use within 3 days after opening

INCOMPATIBILITY -
REMARKS -
References :
76. PRODUCT LEAFLET : Nelin, Biolab Co.,LTD.

71
38.0 PENTAMIDINE INJECTION
38.1 BRAND : DBL Pentamidine Isethionate Injection ®
IM/IV :
Reconstitute with 3 - 5ml WFI/ D5
RECONSTITUTION/
DILUTION
IV Infusion :
Withdraw required dose then further dilute with 50 - 250ml D5/ NS
IM: Inject directly after reconstitution
Slow IV infusion with a patient in a supine position (to reduce

ADMINISTRATION sudden severe hypotension. Infused over 1- 2 hour (the patient is
kept lying down)
Direct IV bolus or rapid administration MUST NOT be used

RT 2 - 8°C RT 2 - 8°C
48 hours under 48 hours for 48 hours under -
fluorescent concentration fluorescent light
STABILITY light 100mg/ml for concentration
and 60mg/ml 1.0mg/ml and
2.5mg/ml
*To avoid microbial contamination, the prepared solution should be

used within 24 hours
INCOMPATIBILITY -
Any solution which are hazy, discolored or contain visible particulate

REMARKS
matter should not be used
References :
77. PRODUCT LEAFLET : DBL Pentamidine Isethionate Injection Hospira Australia Pty
Ltd.
72
39.0 PIPERACILLIN + TAZOBACTAM INJECTION
39.1 BRAND : Tazpen ®
IV :
RECONSTITUTION/
Reconstitute with 20ml WFI/ NS
DILUTION
Further dilute with 50ml NS/ WFI/ D5
Slow IV bolus over 3 – 5 minutes

ADMINISTRATION
Infusion over 20 – 30 minutes
Vials should not be frozen after reconstitution

STABILITY
RT 2 - 8°C RT 2 - 8°C
(recommend to use immediately)
INCOMPATIBILITY Aminoglycosides, Heparin, Vecuronium, Methotrexate
REMARKS -
Reference :
78. PRODUCT LEAFLET : Tazpen, Strides Arcolab Ltd.
73
39.2 BRAND : DBL Piperacillin And Tazobactam For Injection ®
IV :
Reconstitute with 10ml WFI/ NS for 2.25g vial
RECONSTITUTION/
DILUTION
Further dilute with 50ml NS or D5
ADMINISTRATION Slow infusion over 20 - 30 minutes

- 24 hours Use immediately
Lactated ringer solution, solution containing only Sodium

INCOMPATIBILITY
Bicarbonate or having pH basic range
REMARKS -
Reference :
79. PRODUCT LEAFLET : DBL Piperacillin And Tazobactam For Injection Hospira NZ
Limited.
74
39.3 BRAND : Tapicin ®

BRAND NAME Tapicin®
IV :
RECONSTITUTION/
DILUTION
Further dilute with 50ml - 150ml NS/ D5

ADMINISTRATION

STABILITY
RT 2 - 8°C RT 2 - 8°C
24 hours 7days Use immediately
Aminoglycoside, high dose Heparin, oral anticoagulants,

INCOMPATIBILITY Vecuronium, Methotrexate, solution containing Sodium
Bicarbonate
REMARKS -
Reference :
80. PRODUCT LEAFLET : Tapicin, Yung Shin Pharmaceutical (M) Sdn Bhd.
75
39.4 BRAND : Tazocin EF ®
4.5g powder
STRENGTH
BRAND NAME Tazocin EF Injection 4.5g

IV :
Reconstitute with 20ml WFI/ NS/ D5 for 4.5g vial
RECONSTITUTION/
Further dilute with 50ml to 150ml NS/ WFI/ D5
DILUTION
*Maximum recommended volume of WFI per dose is 50ml
ADMINISTRATION

RT 2 - 8°C RT 2 - 8°C
STABILITY
24 hours 48 hours Use Immediately
Not to be frozen
Aminoglycoside, solutions containing Sodium Bicarbonate alone or
INCOMPATIBILITY solutions that significantly alter the pH, blood products or Albumin
hydrolysates
REMARKS -
Reference :
81. PRODUCT LEAFLET : Tazocin EF Pfizer Limited.
76
40.0 POLYMYXIN B INJECTION
40.1 BRAND : Poly-B ®
STRENGTH 500,000 units powder
IM :
Reconstitute with 2ml WFI /NS
DILUTION Reconstitute with 5ml of D5
Further dilute with 300 – 500ml of D5
Intrathecal: Reconstitute with 10ml NS
IM (not recommended routinely because of severe pain at

injection sites particularly in infants and children)
ADMINISTRATION IV: infusion durations of 60 - 120 minutes
Intrathecal (treatment of choice for Ps. Aeruginosa meningitis) :

Administer 50, 000 units (1ml) intrathecally

RT 2 - 8°C RT 2 - 8°C
STABILITY
-
INCOMPATIBILITY
References:
82. PRODUCT LEAFLET : Polymyxin B for injection USP, XGen Pharmaceuticals Inc.
83. PRODUCT LEAFLET : Poly-B, Samarth Life Sciences Pt Ltd.
77
41.0 STREPTOMYCIN INJECTION
41.1 BRAND : Streptin ®
STRENGTH 1g powder
IM :
RECONSTITUTION/
Reconstitute with 3.2 - 3.5ml of WFI/NS
DILUTION
(final concentration : 250mg/ml)

INCOMPATIBILITY -
Protect from light and freezing. Exposure to light causes

REMARKS
darkening of solution without apparent loss of potency
References :
84. PRODUCT LEAFLET : Streptin, SM Pharmaceuticals Sdn Bhd.

78
41.2 BRAND : Meiji ®
STRENGTH 1g powder
IM :
Reconstitute with 3.2ml of WFI/NS
RECONSTITUTION/
DILUTION
Inhalation :
Reconstitute with 5ml of NS
Further dilute with 25 - 50ml NS
IM
ADMINISTRATION
Inhalation: Nebulize and inhale 1 -15ml of solution every 4 to
6hrs

INCOMPATIBILITY -
Protect from light
REMARKS Concomitant IM may be required in many cases for inhaled
streptomycin
References :
85. PRODUCT LEAFLET : Meiji, PT Meiji Indonesian Pharmaceutical Industries.

102. Medscape : Streptomycin. Incompatibility;
http://reference.medscape.com/drug/streptomycin-342682#11.
79
41.3 BRAND : Sterile Streptomycin Sulfate For Injection
STRENGTH 1g powder
IM :
RECONSTITUTION/
DILUTION
INCOMPATIBILITY
-
Reference :
86. PRODUCT LEAFLET : Sterile Streptomycin Sulfate for Injection, Karnataka

Antibiotics & Pharmaceuticals Limited.
80
42.0 SULFAMETHOXAZOLE + TRIMETHOPRIM INJECTION
42.1 BRAND : DBL Sulfamethoxazole 400mg & Trimethoprim 80mg
STRENGTH Sulfamethoxazole 400mg/ Trimethoprim 80mg
IV :
Dilute : 1 ampoule to 125ml NS/ D5
RECONSTITUTION/ 2 ampoule to 250ml NS/ D5
DILUTION 3 ampoule to 500ml NS/ D5
In fluid restriction, dilute 1 ampoule to 75ml D5
ADMINISTRATION IV infusion should not exceed 1½ hours

RT 2 - 8°C RT 2 - 8°C
STABILITY
Information not available 24 hours NA
INCOMPATIBILITY -
REMARKS Do not administer IM
References :
87. PRODUCT LEAFLET : DBL Sulfamethoxazole 400mg & Trimethoprim 80mg

Hameln pharmaceuticals GmbH.
81
43.0 VANCOMYCIN INJECTION
43.1 BRAND : Vancomycin Hydrochloride for Injection
IV :
Further dilute with at least 100 ml of NS/ D5
RECONSTITUTION/
DILUTION 1g : Reconstitute with 20ml of WFI
Further dilute with at least 200 ml of NS/ D5
≤1g : Infusion over a period of at least 60 minutes, or at

maximum infusion rates of 10mg/min, whichever is longer
ADMINISTRATION
>1g: Infusion at rate 10mg/min

2 days 14 days - 14 days (D5 or NS)
INCOMPATIBILITY -
Concentrations of not more than 5mg/ml and rates of not more

REMARKS than 10mg/min are recommended to prevent infusion related
reaction ( Red Man Syndrome)
References :
88. PRODUCT LEAFLET : Vancomycin Hydrochloride for Injection, USP, Hospira Inc.
103. http://www.globalrph.com/vancomycin_dilution.htm.
82
43.0 VANCOMYCIN INJECTION
43.2 BRAND : Vancotex Injection 500mg
IV :
RECONSTITUTION/
For 500mg : Reconstitute with 10ml of WFI
DILUTION
Further dilute with at least 100 ml of NS/D5
≤1g : Infusion over a period of at least 60 minutes, or at maximum

infusion rates of 10mg/min, whichever is longer
ADMINISTRATION
>1g: Infusion at rate 10mg/min
STABILITY Freshly prepared and discard the unused portion
INCOMPATIBILITY -
Maximum concentration allowed is 10mg/ml for fluid restriction but

REMARKS
increased the risk of infusion-related effects ( Red Man Syndrome)
Reference :
89. PRODUCT LEAFLET : Vancotex Injection Fisiopharma S.r.L, Nucleo Industriale.
83
44.0 VORICONAZOLE INJECTION
44.1 BRAND : Vfend ®
IV :
Reconstitute with 19ml WFI (final concentration: 10mg/ml)
Withdraw the required amount of 10mg/ml VFEND concentrate

(Refer Table 1)
RECONSTITUTION/
DILUTION Then, further dilute the concentrate with NS/ D5 up to:-
i) 50ml : Dose of 25 - 250mg
ii) 100ml : Dose of 251 - 500mg
iii) 150ml : Dose of 501 - 600mg
(final concentration should be within 0.5 - 5mg/ml)
Infusion over 1 - 2 hours

ADMINISTRATION
At a maximum rate of 3mg/kg/hour

Blood products and concentrated electrolytes MUST NOT be

INCOMPATIBILITY infused concomitantly with Voriconazole even in separate infusion
lines
Not recommended for bolus injection

REMARKS Refer to table 1 for required volumes of 10mg/ml VFEND
Concentrate table
Reference ;
90. PRODUCT LEAFLET : Vfend, Pfizer Inc.
84
Table 1
Required Volumes of 10 mg/ml VFEND Concentrate
Volume of VFEND Concentrate (10mg/ml) required for:

Body
Weight 3 mg/kg dose 4 mg/kg dose 6 mg/kg dose 8 mg/kg dose 9 mg/kg dose
(kg) (number of (number of (number of (number of (number of
vials) vials) vials) vials) vials)
10 - 4.0ml (1) - 8.0 ml (1) 9.0 ml (1)
15 - 6.0ml (1) - 12.0 ml (1) 13.5 ml (1)
20 - 8.0ml (1) - 16.0 ml (1) 18.0 ml (1)
25 - 10.0ml (1) - 20.0 ml (1) 22.5 ml (2)
30 9.0ml (1) 12.0ml (1) 18.0ml (1) 24.0 ml (2) 27.0 ml (2)
35 10.5ml (1) 14.0ml (1) 21.0ml (2) 28.0 ml (2) 31.5 ml (2)
40 12.0ml (1) 16.0ml (1) 24.0ml (2) 32.0 ml (2) 36.0 ml (2)
45 13.5ml (1) 18.0ml (1) 27.0ml (2) 36.0 ml (2) 40.5 ml (3)
50 15.0ml (1) 20.0ml (1) 30.0ml (2) 40.0 ml (2) 45.0 ml (3)
55 16.5ml (1) 22.0ml (2) 33.0ml (2) 44.0 ml (3) 49.5 ml (3)
60 18.0ml (1) 24.0ml (2) 36.0ml (2) 48.0 ml (3) 54.0 ml (3)
65 19.5ml (1) 26.0ml (2) 39.0ml (2) 52.0 ml (3) 58.5 ml (3)
70 21.0ml (2) 28.0ml (2) 42.0ml (3) - -
75 22.5ml (2) 30.0ml (2) 45.0ml (3) - -
80 24.0ml (2) 32.0ml (2) 48.0ml (3) - -
85 25.5ml (2) 34.0ml (2) 51.0ml (3) - -
90 27.0 ml (2) 36.0 ml (2) 54.0 ml (3) - -
95 28.5 ml (2) 38.0 ml (2) 57.0 ml (3) - -
100 30.0 ml (2) 40.0 ml (2) 60.0 ml (3) - -
85
45.0 ZIDOVUDINE INJECTION
45.1 BRAND : Retro ®
MUST be diluted prior to administration
IV :
Withdraw the required dose from the vial
RECONSTITUTION/
Then, further dilute with D5 up to :-
DILUTION
i) 50ml : Dose of ≤200mg
ii) 100ml : Dose of 201 – 400mg
(final concentration should NOT exceed 4mg/ml)
Intermittent infusion: Infused over 1 hour
ADMINISTRATION Continuous infusion (Prevention of maternal - fetal HIV

transmission): 2mg/kg infused over 1 hour, followed by
1mg/kg/hr until umbilical cord is clamped

Information not available 48 hours
INCOMPATIBILITY -
References :
91. PRODUCT LEAFLET : Retro, Glaxo Wellcome Operations, ViiV Healthcare.

107. http://www.globalrph.com/zidovudine_dilution.htm.
86
NON-FORMULARY INJECTION
1. Daptomycin Injection
BRAND : Cubicin ®
STRENGTH 500 mg lyophilized powder
IV :
RECONSTITUTION/
Reconstitute with 10ml NS
DILUTION
IV :
ADMINISTRATION i) IV slow bolus, Inject over 2 minutes after reconstitution
ii) Infuse over 30 minutes

STABILITY
RT 2 - 8°C RT 2 - 8°C
12 hours 48 hours 12 hours 48 hours
INCOMPATIBILITY Dextrose containing diluents
AVOID vigorous shaking of the vial during or after

REMARKS
reconstitution
References :
92. PRODUCT LEAFLET : Cubicin, Cubist Pharmaceuticals, Inc.

108. http://www.globalrph.com/daptomycin_dilution.htm.
87
2. Liposomal Amphotericin B Injection

BRAND : Ampholip ®

DILUTION Further dilute with 40ml of D5 (1mg/ml)
IV :
ADMINISTRATION
Infuse at a rate of 2.5 mg/kg/hr
INCOMPATIBILITY NS
 Protect from light

 Do not use an on-line microbial filter
 Desired dose should withdraw using an 18G needle
 Further dilution should done using 5μ filter needle
supplied with each vial pack
REMARKS  Mix the contents of the bag by shaking the infusion
bag every two hours
 An existing IV line should flushed with D5 before
infusion of Ampholip
 An initial test dose of 1.0 mg should be infused
intravenously over 15 minutes
Reference :
93. PRODUCT LEAFLET : Ampholip Bharat Serums And Vaccines Limited
88
3. Micafungin Sodium Injection

BRAND : Mycamine ®
IV :
RECONSTITUTION/
DILUTION
Further dilute with 100ml with NS/ D5
IV:
ADMINISTRATION
Infuse over 1 hour

STABILITY
RT 2 - 8°C RT 2 - 8°C
24 hours NA 24 hours NA
INCOMPATIBILITY -
Protect from light

REMARKS
More rapid infusions may result in more frequent histamine
mediated reaction
Reference :
94. PRODUCT LEAFLET : Mycamine, Cubist Pharmaceuticals, Inc.
89
4. Colistimethate Sodium (Polymyxcin E) Injection

BRAND : Colomycin ®
STRENGTH One million units powder

IV :
Reconstitute with 10ml of NS
RECONSTITUTION/
DILUTION
Nebusation solution :
1 million unit – add 2ml NS
2 million unit – add 4ml NS
IV :
Infuse over 30 minutes
ADMINISTRATION
If Totally Implantable Venous Access Device (TIVAD) in place,
bolus injection of up to 2 million units in 10ml given over a
minimum of 5 minutes
Preparation After After Dilution

Reconstitution
Intravenous NA 24 hours NA 24 hours
Nebulisation NA 24 hours NA NA
solution
-
INCOMPATIBILITY
-
REMARKS
References :
95. PRODUCT LEAFLET : Colomycin, Xellia Pharmaceuticals APS.

104. https://www.medicines.org.uk/emc/medicine/1590.
90
5.1 Tigecyclin Injection

BRAND : Tygacil ®
STRENGTH 50 mg lyophilized powder
IV :
Reconstitute with 5.3mL* of NS/ D5
RECONSTITUTION/ Withdraw 5ml from reconstituted solution & further dilute with
DILUTION 100ml with NS/ D5
Maximum concentration per bag 1mg/ml
IV :
ADMINISTRATION
Infusion over 30 minutes to 1 hour

24 hours NA 24 hours 48 hours
-
INCOMPATIBILITY
-
REMARKS
* Each vial contains a 6% overage. Thus, 5ml of reconstituted solution is equivalent to

50mg of the drug
References :
96. PRODUCT LEAFLET : Tygacil, Wyeth Pharmaceuticals Inc.

91
6.0 Pentamidine Isethionate BP Injection

BRAND : Pentacarinat ®
Nebulisation solution :
Add 4 - 6mL of WFI
IM :
RECONSTITUTION/
DILUTION
IV infusion :
Reconstitute with 3 - 5ml WFI
Further dilute with 50ml - 250ml with NS /D5
IV infusion :
ADMINISTRATION
Infuse over 1 hour

Information not available NA 24
(recommend to use immediately) hours
-
INCOMPATIBILITY
Sudden, severe hypotension may occur after a single dose of

Pentamidine Isethionate has been given parenterally:
REMARKS - Baseline blood pressure should be established
- Patients should receive the drug during lying down
- Blood pressure should be closely monitored
* Reserved for nebulization only.

If IV needed , use brand DBL Pentamidine (refer to 4.38 Pentamidine Inj; page 72)
References :
97. PRODUCT LEAFLET : Pentacarinat Sanofi-aventis New Zealand Limited.

109. Martidale : The Complete Drug Reference. 33th ed.
92
7. Quinine Dihydrochloride Injection
BRAND : Malakin Injection 2mL ®

DILUTION Dilute with 250ml - 500ml NS
IV :
i. 7 mg dihydrochloride salt/kg infused over 30 minutes
Followed by 10mg salt/kg over a period of 4 hours
ADMINISTRATION
ii. For severe malaria : 20 mg of the dihydrochloride salt (16.7
mg base)/kg infused over 4 hours
Followed by 10mg salt/kg infused over 2 - 8 hours

-
INCOMPATIBILITY
REMARKS -
References :
98. PRODUCT LEAFLET : Malakin Injection Duopharma (M) Sdn Bhd.

93
ABBREVIATION
BW : Body weight
D5 : Dextrose 5%
GA : General Anaesthesia
IM : Intramuscular
IV : Intravenous
LR : Lactate Ringer
N/A : Not Applicable
NS : Sodium Chloride 0.9%
RF : Refrigerator (2 - 8 C)
RT : Room Temperature (15 - 30 C)
SC : Subcutaneous
WFI : Water For Injection
Wt : Weight
94
REFERENCES:
REFERENCES
1. PRODUCT LEAFLET : Zovirax For Infusion 250mg, GlaxoSmithKline.

2. PRODUCT LEAFLET : Medovir 250mg Injectible, Medochemie.
3. PRODUCT LEAFLET : DBL Acyclovir Hospira.
4. PRODUCT LEAFLET: Vaxcel Acyclovir Kontra Pharma.
5. PRODUCT LEAFLET : Eraxis, Pfizer.
6. PRODUCT LEAFLET : Apalin, CCM Duopharma Bio Tech.
7. PRODUCT LEAFLET : Selemycin Medochemie Ltd, Cyprus.
8. PRODUCT LEAFLET : Augmentin Intravenous GlaxoSmithKline
9. PRODUCT LEAFLET : Clamentin Injection, Yung Shin Pharmaceutical Ind. Co., Ltd.
10. PRODUCT LEAFLET : Co-Amoxiclav Injection Averroes Pharmaceuticals Sdn Bhd.
11. PRODUCT LEAFLET : Ampicillin Sodium for Injection B, Karnataka Antibiotics &
Pharmaceuticals Limited, India; July 2009.
12. PRODUCT LEAFLET : Pamecil, Medochemie Ltd, Selangor.
13. PRODUCT LEAFLET : Standacillin, Sandoz.
14. PRODUCT LEAFLET : Ampicillin & Sulbactam powder for injection Karnataka
15. PRODUCT LEAFLET : Sulbacin, Unichem.
16. PRODUCT LEAFLET : Amphotret Bharat Serums And Vaccines Ltd.
17. PRODUCT LEAFLET : Artesun, Guilin Pharmaceutical Co Ltd.
18. PRODUCT LEAFLET : Azee, Cipla United.
19. PRODUCT LEAFLET : Zitromax, Pfizer.
20. PRODUCT LEAFLET : Retarpen, Sandoz.
21. PRODUCT LEAFLET : Sterile Penicillin G benzathine 2.4 mega units, Karnataka
22. PRODUCT LEAFLET : Cancidas, Merck Sharp & Dohme.
23. PRODUCT LEAFLET : Cefazolin Sandoz.
24. PRODUCT LEAFLET : Reflin, Ranbaxy.
25. PRODUCT LEAFLET : Verapime, Demo S.A Pharmaceutical Industry.
26. PRODUCT LEAFLET : Vaxcel Cefepime Kotra Pharma (M) Sdn. Bhd.
27. PRODUCT LEAFLET : Forpar, Cipla (M) Sdn. Bhd. 2014.
28. PRODUCT LEAFLET : Megapime, Alkem Lab Ltd. 2006.
29. PRODUCT LEAFLET : Sefepim, Hovid Sdn Bhd. 2014.
30. PRODUCT LEAFLET : Rekaxime, Duopharma (M) Sdn Bhd. 2011.
31. PRODUCT LEAFLET : Claraxim, Siam Bheasach Co. Ltd. 2006.
32. PRODUCT LEAFLET : Claforan, Aventis Pharma.
33. PRODUCT LEAFLET : Vaxcel Cefotaxime, Kotra Pharma (M) Sdn.Bhd. .
34. PRODUCT LEAFLET : Bicafar, Duopharma (M) Sdn Bhd. 2012.
35. PRODUCT LEAFLET : Vaxcel Cefoperazone, Kotra Pharma (M) Sdn.Bhd. .
36. PRODUCT LEAFLET : Vaxcel Cefobactam, Kotra Pharma (M) Sdn.Bhd. .
37. PRODUCT LEAFLET : Cefper Biolab Co. LTD, 2009.
38. PRODUCT LEAFLET : Cefoperazone & Sulbactam 1.0G, Karnataka Antibiotics &
Pharmaceuticals Limited, 2010.
39. PRODUCT LEAFLET : Zinforo, Facta Farmaceutici S.p.A, October 2012.
40. PRODUCT LEAFLET : Cefatum, Duopharma (M) Sdn Bhd, 6 August 2010.
41. PRODUCT LEAFLET : Fortum, GlaxoSmithKline.
42. PRODUCT LEAFLET : Unocef, Duopharma (M) Sdn Bhd, 27 July 2010.
43. PRODUCT LEAFLET : Rocephin, Roche.
44. PRODUCT LEAFLET : Zinacef, GlaxoSmithKline.
95
45. PRODUCT LEAFLET : Anikef Duopharma (M) Sdn Bhd, 2 September 2013.
46. PRODUCT LEAFLET : Ciproxol Ain Medicare Sdn. Bhd.
47. PRODUCT LEAFLET : Ciprobay, Bayer Co. (Malaysia) Sdn Bhd.
48. PRODUCT LEAFLET : Ufexil DEMO S.A.
49. PRODUCT LEAFLET : Dalacin C, Pfizer Inc.
50. PRODUCT LEAFLET : Tidact, Yung Shin Pharmaceutical Ind. Co., Ltd.
51. PRODUCT LEAFLET :Cloxacillin Sodium, Karnataka Antibiotics & Pharmaceuticals
Ltd.
52. PRODUCT LEAFLET : Penicilin G Sodium Sandoz, Sandoz GmbH
53. PRODUCT LEAFLET : Benzyl Penicillin For Injection, Karnataka Antibiotics &
Pharmaceuticals Ltd.
54. PRODUCT LEAFLET : Doribax, Shionogi & Company Ltd.
55. PRODUCT LEAFLET : Invanz, Laboratories Merck Sharp & Dohme-Chibret.
56. PRODUCT LEAFLET : Erythromycin 500mg Injection Fisiopharma S.r.L.
57. PRODUCT LEAFLET : Diflucan, Pfizer.
58. PRODUCT LEAFLET : Garasent, Duopharma (M) Sdn Bhd.
59. PRODUCT LEAFLET : Tienem Merck Sharp & Dohme.
60. PRODUCT LEAFLET : Kanamycin sulfate injection meiji, Thai Meiji Pharmaceutical
Co., Ltd.
61. PRODUCT LEAFLET : Kanamycin injection “Yung Shin”, Yung Shin Pharmaceutical
Ind. Co., Ltd.
62. PRODUCT LEAFLET : Kancin-L, Altantic Laboratories Corporation Ltd.
63. PRODUCT LEAFLET : Cravit, Daiichi Sankyo.
64. PRODUCT LEAFLET : Levofloxol Ain Medicare Sdn. Bhd.
65. PRODUCT LEAFLET : Glevo I.V Glenmark Pharma.
66. PRODUCT LEAFLET : Zyvox Pfizer Inc.
67. PRODUCT LEAFLET : Meronem, AstraZeneca.
68. PRODUCT LEAFLET : DBL TM Meropenem Hospira NZ Limited.
69. PRODUCT LEAFLET : Monem, Biolab.
70. PRODUCT LEAFLET : Meraparon, Novartis Corporation.
71. PRODUCT LEAFLET : Metronidazole, B. Braun Medical Industries Sdn. Bhd.
72. PRODUCT LEAFLET : Metronol Ain Medicare Sdn. Bhd.
73. PRODUCT LEAFLET : Metrogyl, Unique Pharmaceutical Laboratories.
74. PRODUCT LEAFLET : Avelox, Bayer Schering Pharma AG, Germany.
75. PRODUCT LEAFLET : Lotifar, Duopharma (M) Sdn Bhd.
76. PRODUCT LEAFLET : Nelin, Biolab Co.,LTD.
77. PRODUCT LEAFLET : DBL Pentamidine Isethionate Injection Hospira Australia Pty
Ltd.
78. PRODUCT LEAFLET : Tazpen, Strides Arcolab Ltd.
79. PRODUCT LEAFLET : DBL Piperacillin And Tazobactam For Injection Hospira NZ
Limited.
80. PRODUCT LEAFLET : Tapicin, Yung Shin Pharmaceutical (M) Sdn Bhd.
81. PRODUCT LEAFLET : Tazocin EF Pfizer Limited.
82. PRODUCT LEAFLET : Polymyxin B for injection USP, XGen Pharmaceuticals Inc.
83. PRODUCT LEAFLET : Poly-B, Samarth Life Sciences Pt Ltd.
84. PRODUCT LEAFLET : Streptin, SM Pharmaceuticals Sdn Bhd.
85. PRODUCT LEAFLET : Meiji, PT Meiji Indonesian Pharmaceutical Industries.
86. PRODUCT LEAFLET : Sterile Streptomycin Sulfate for Injection, Karnataka
Antibiotics & Pharmaceuticals Limited.
87. PRODUCT LEAFLET : DBL Sulfamethoxazole 400mg & Trimethoprim 80mg
Hameln pharmaceuticals GmbH.
88. PRODUCT LEAFLET : Vancomycin Hydrochloride for Injection, USP, Hospira Inc.
89. PRODUCT LEAFLET : Vancotex Injection Fisiopharma S.r.L, Nucleo Industriale.
90. PRODUCT LEAFLET : Vfend, Pfizer Inc.
91. PRODUCT LEAFLET : Retro, Glaxo Wellcome Operations, ViiV Healthcare.
96
92. PRODUCT LEAFLET : Cubicin, Cubist Pharmaceuticals, Inc.

93. PRODUCT LEAFLET : Ampholip Bharat Serums And Vaccines Limited
94. PRODUCT LEAFLET : Mycamine, Cubist Pharmaceuticals, Inc.
95. PRODUCT LEAFLET : Colomycin, Xellia Pharmaceuticals APS.
96. PRODUCT LEAFLET : Tygacil, Wyeth Pharmaceuticals Inc.
97. PRODUCT LEAFLET : Pentacarinat Sanofi-aventis New Zealand Limited.
98. PRODUCT LEAFLET : Malakin Injection Duopharma (M) Sdn Bhd.
102. Medscape : Streptomycin. Incompatibility;
http://reference.medscape.com/drug/streptomycin-342682#11.
103. http://www.globalrph.com/vancomycin_dilution.htm.
104. https://www.medicines.org.uk/emc/medicine/1590.
105. Injectable Drugs Dilution 2010, Bahagian Perkhidmatan Farmasi Perak.
Kuala Lipis.
107. http://www.globalrph.com/zidovudine_dilution.htm.
108. http://www.globalrph.com/daptomycin_dilution.htm.
109. Martidale : The Complete Drug Reference. 33th ed.
110. Medication Errors and Syringe Safety Are Top Concerns for Nurses According to
New National Study [press release].http://www.nursingworld.org/Functional Menu
Categories/ Media Resources /Press Releases/2007
111. Intravenous Drugs Preparation & Administration Quick Reference, Medical
Department & Pharmacy Department Kuala Lumpur Hospital, 2011
112. John D & Rebecca L, 2010. Guide to the Safe Preparation and Administration of
Intravenous (IV) Antibiotics at Home. http://www.newcastle-
hospitals.org.uk/downloads/cardiothoracic/Patient_info_-
_safe_prep_and_admin_of_IV_ab.pdf
113. Dilution Protocol 2010, Hospital Selayang 2nd Edition
97

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Antimicrobial Dilution Protocol (AmDP)

This is a general guide for dilution of antimicrobial injections within

Pharmaceutical Services Division

ANTIMICROBIAL DILUTION PROTOCOL

This is a publication of Pharmaceutical Services Division, Penang State Health

This guideline can be downloaded from JKNPP website at

Pharmaceutical Services Division,

Tel: 04- 2292319

Fax: 04- 2280314

Madam Sherene Tan Su Ann, Madam Chua Cheah Chin,

Madam Che Ropani Binti Talib, Madam Saparbee Binti Mohamad,

Madam Malathi D/O Govindasamy,

Oiyammaal D/O Maruthan Chelliah Syazleen Binti Razak

Subramaniam S/O Thanimalai Celine Choong Yen Ching

Nurul Ain’ Binti Satar Ong Chiou Ting

Nasira Binti Mohamed Ayub Tan Huey Yih

Ng Wei Min Afida Amir Binti Ismet Amir Mohd. Idris

Tan Yin Shan Nurzawani Binti Yusof

Tan Pei Ling

Rohaizan Binti Mohd Hanafiah Lim Shiou Hui

Nasira Binti Mohamed Ayub

DIRECTOR PENANG STATE HEALTH DEPARTMENT

Dilution of antimicrobial is one of the essential strategies to ensure the correct

DATO’ DR. SUKUMAR MAHESAN

DEPUTY DIRECTOR (PHARMACY) OF PENANG

Finally, I would like to express my appreciation to all the members in working

Deputy Director (Pharmacy) Of Penang State Health Department

5.39 Piperacillin/ Tazobactam Inj……………………………………………………….. 73 – 76

Intravenous therapy is the most important form of treatment in hospitalized

Study of Injectable Medication Errors done by American Nurses Association

ABOUT ANTIMICROBIAL DILUTION PROTOCOL (AmDP)

 Serves as a drug reference for Adult cases ONLY. Clinical

 Included antibiotics, antivirals and antifungals injection listed in

 Most of the information is based on brand and manufacturer

 Drugs are listed alphabetical in orders and subclass according to

GUIDE IN USING AmDP

1. Check the generic name of antimicrobial injection.

2. Check the brand name of antimicrobial injection.

3. Search page number of generic and brand name at content page.

4. Read all information in the table before reconstitute or dilute the

5. If the drug or the brand is not listed in the protocol, contact

1. All preparations should be done using aseptic technique.112

 This general information may not be applicable to all the medications

1.0 ACYCLOVIR INJECTION

1.1 BRAND : Zovirax ®

STRENGTH 250mg Powder

RECONSTITUTION/ Further dilute with:

ADMINISTRATION Slow IV infusion over 1 hour

After Reconstitution After Dilution

1. PRODUCT LEAFLET : Zovirax For Infusion 250mg, GlaxoSmithKline.

1.0 ACYCLOVIR INJECTION

1.2 BRAND : Medovir ®

STRENGTH 250mg powder

Further dilute with NS to give concentration not greater than

ADMINISTRATION IV infusion over at least 1 hour

After Reconstitution After Dilution

Biological or colloidal solutions

2. PRODUCT LEAFLET : Medovir 250mg Injectible, Medochemie.

1.0 ACYCLOVIR INJECTION

1.3 BRAND : DBL Acyclovir Intravenous Infusion ®

STRENGTH 250mg Powder

Further dilute with NS to give concentration not greater than

ADMINISTRATION IV infusion only, to be given over a period at least 1 hour