@article {Jamiesone53, author = {Conor Jamieson and Michael Charles Allwood and Donata Stonkute and Andrew Wallace and Alan-Shaun Wilkinson and Tim Hills}, editor = {,}, title = {Investigation of meropenem stability after reconstitution: the influence of buffering and challenges to meet the NHS Yellow Cover Document compliance for continuous infusions in an outpatient setting}, volume = {27}, number = {e1}, pages = {e53--e57}, year = {2020}, doi = {10.1136/ejhpharm-2018-001699}, publisher = {BMJ Specialist Journals}, abstract = {Objectives To determine the influence of different buffers, pH and meropenem concentrations on the degradation rates of meropenem in aqueous solution during storage at 32{\textdegree}C, with the aim of developing a formulation suitable for 24-hour infusion in an ambulatory elastomeric device, compliant with the latest National Health Service Pharmaceutical Quality Assurance Committee Yellow Cover Document (YCD) requirements.Methods Meropenem was diluted to 6.25 mg/mL and 25 mg/mL in aqueous solutions adjusted to various pH with phosphate or citrate buffer and assessed for stability. Meropenem concentrations were determined using a validated stability-indicating high-performance liquid chromatography method at time 0 and following storage for up to 24 hours at 32{\textdegree}C as per the YCD requirements.Results Degradation was observed to be slowest in citrate buffer around pH 7 and at a meropenem concentration of 6.25 mg/mL; however, losses exceeded 10\% after storage for 24 hours at 32{\textdegree}C in all of the diluents tested in the study.Conclusions Meropenem at concentrations between 6.25 mg/mL and 25 mg/mL as tested is not sufficiently stable to administer as a 24-hour infusion in ambulatory device reservoirs. If the YCD 95\% minimum content limit is applied, the infusion period must be reduced to less than 6 hours for body-worn devices, especially at the higher concentration studied (25 mg/mL). This limits the possibility of using elastomeric devices to deliver continuous infusions of meropenem as part of a wider outpatient parenteral antimicrobial therapy service.}, issn = {2047-9956}, URL = {https://ejhp.bmj.com/content/27/e1/e53}, eprint = {https://ejhp.bmj.com/content/27/e1/e53.full.pdf}, journal = {European Journal of Hospital Pharmacy} }