Background: The Guidelines for Parenteral and Enteral Nutrition in Japan state that parenteral fat emulsion can be infused through a secondary administration set. We tested the compatibility of fat emulsion with antibiotics in piggyback infusions in terms of changes in the size distribution of fat particles. Methods: Test mixtures of 5% glucose solution, fat emulsion, and 25 antibiotic agents were prepared in the ratio appropriate for piggyback infusion (33: 10: 40) and analyzed serially for the number of fine particles by size using a light-shielded automatic fine particle counter. Results: No marked changes were observed in the 12 β-lactam antibacterial drugs, clindamycin phosphate, teicoplanin, trimethoprim/sulfamethoxazole, and micafungin sodium even at 24 h after preparation. The particle size in the mixture containing vancomycin hydrochloride, levofloxacin hydrate, metronidazole, and fluconazole gradually increased after preparation. The particle size in the mixture containing gentamicin sulfate, arbekacin sulfate, minocycline hydrochloride, ciprofloxacin, and fosfomycin sodium changed significantly after preparation. Conclusions: The changes in the particle size observed with some drugs suggest that they may cause changes in the lipid particle size during administration and, therefore, those antibiotics agents should not be administered concurrently with fat emulsion.

1.
Iriyama K: Lipid emulsion in total parenteral nutrition. Jpn J Nutr Assess 2009; 26: 324–327.
2.
Japanese Society for Parenteral and Enteral Nutrition (ed): The Guidelines for Parenteral and Enteral Nutrition, the 3rd edition. Tokyo, Shorinsha, 2013.
3.
Maniwa Y, Tanimura H, Shimamoto T, Nakamura K, Hirao Y, Minami Y, Imagawa T: Reevaluation of total nutrient admixtures (TNAs). Jap J Surg Metab Nutr 1997; 31: 17–22.
4.
Nakagawa Y (ed): The Practice of Prediction of Incompatibility with Injection. Osaka, Iyaku Journal Co., Ltd., 1997, pp 111–121.
5.
Myotoku M: The venous accesses management for nutrition therapy based on a characteristic of infusion solution preparation. J Jpn Soc Parenter Enteral Nutr 2014; 29: 717–724.
6.
The Japanese pharmacopoeia (ed 16). Tokyo, Hirokawa-Shoten, 2011, pp B575–B582.
7.
Trissel LA, Gilbert DL, Martinez JF, Baker MB, Walter WV, Mirtallo JM: Compatibility of medications with 3-in-l parenteral nutrition admixtures. J Parenter Enteral Nutr 1999; 23: 67–74.
8.
Lumpkin MM: Safety alert: hazards of precipitation associated with parenteral nutrition. Am J Hosp Pharm 1994; 51: 1427–1428.
9.
Iriyama K, Tonouchi H, Azuma T, Suzuki H, Carpentier YA: Capacity of high-density lipoprotein for donating apolipoproteins to fat particles in hypertriglyceridemia induced by fat infusion. Nutrition 1991; 7: 355–357.
10.
Iriyama K, Tsuchibashi T, Miki C, Kalembeyi I, Li H, Urata H, Saitoh R: Elimination rate of fat emulsion particles from plasma in Japanese subjects as determined by a triglyceride clamp technique. Nutrition 1996; 12: 79–82.
11.
Arai K, Horiuchi M, Ogino M, Sato S, Yoshino K, Machishima H: Stability of fat emulsions for intravenous use in the market. Jpn J Hosp Pharm 1984; 10: 431–436.
12.
The United States Pharmacopeial Convention: < 729> globule size distribution in lipid injectable emulsions. Pharmacopeial Forum 2009; 35: 626–628.
13.
Inoue Y, Katsura T, Kokuba Y, Fujimaki M, Kajiwara K: Can lipid emulsion be administered as secondary piggyback infusion through primary TPN infusion line? – Studies for the changes of lipid particle size. J Jpn Soc Parenter Enteral Nutr 2014; 29: 863–870.
14.
Information for Healthcare Professionals: Ceftriaxone (marketed as Rocephin and generics)? U.S. Food and Drug Administration, April 2, 2009.
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