Com piled by Pharmacy Department Version 3 (July 2017)

Review Date: 2 years or earlier if necessary Administration of Antibiotic Injections

Type of Rate in fluid restricted
Antibiotic Directions Rate Fluid restricted patients
administration patients
Av ailable as powder f or reconstitution or Concentrate f or Solution f or Inf usion
Powder f or reconstitution: Add 10mL W or NS to 250mg v ial or 20mL to 500mg v ial.
(N.B. The reconstituted solution is light y ellow and slightly opalescent. Discard the solution if it becomes cloudy
IV Infusion only Central line ONLY -
Aciclovir or cry stals appear bef ore or during the inf usion.) At least 1 hour At least 1 hour
undiluted (25mg/1mL)
Both forms require further dilution: Doses up to 500mg add to 100mL NS. Doses 500mg - 1g add to 250mL
NS
Pref erably v ia central line or, if this is not possible, use large peripheral v ein
IV Injection Giv e undiluted or dilute with 10-20mL NS or G
Multiple daily 2-3 minutes
Pref erably v ia central line or, if this is not possible, use large peripheral v ein
dosing
Amikacin Dilute the required dose in 100mL NS or G
IV Infusion for 30 to 60 minutes. Required dose to be diluted up to
Pref erably v ia central line or, if this is not possible, use large peripheral v ein 30 minutes.
ONCE daily dosing 50mL total v olume.
(N.B. Amikacin solution may darken f rom colourless to pale y ellow.)
IM Injection No reconstitution or dilution required

For doses of 1g or less ONLY . Pref erably v ia central line or, if this is not possible, use large peripheral v ein
Reconstitute 250mg v ial with 5mL W, 500mg with 10mL W, 1g with 20mL W.
IV Injection 3-4 minutes
N.B. Reconstituted solutions are normally a pale straw colour; howev er, a transient pink colour or slight
opalescence may appear during reconstitution.
Reconstitute as f or IV injection
Amoxicillin
IV Infusion Add reconstituted solution to 100mL NS (P) or G ov er 30-60 minutes
Pref erably v ia central line or, if this is not possible, use large peripheral v ein
Do not inject more than 1 g of amoxicillin at one time in adults.
IM Injection Reconstitute 250mg v ial with 1.5mL W, 500mg v ial with 2.5mL W, or 1g v ial with 2.5mL W or 1% lidocaine
hy drochloride
Central line ONLY
Reconstitute 600mg v ial with 4 to 10 mL of W or NS, and 1200mg v ials with a minimum of 8mL W or NS Less than 1200mg ov er 3- 5 minutes
Reconstitute 600mg v ial with 4mL
IV Injection Contents of the v ial should be withdrawn and f urther diluted: For 1200mg and abov e maximum rate is
of W or NS, and a minimum of
600mg v ial to a f inal v olume of 10mL and 1200mg v ial to a f inal v olume of 20mL 300mg/min
8mL to 1200mg v ials
Benzylpenicillin
Reconstitute as per IV injection then add to 100mL NS or G (Use G in patients with a history of renal f ailure Minimum f inal v olume as per IV
IV Infusion 30-60 minutes 30-60 minutes
and/or heart f ailure) injection
IM Injection Reconstitute 600mg v ial with 1.6 to 2.0 mL of W

Reconstitute 500 mg v ial with 5mL W, 1 g v ial with 10mL W, 2 g v ial with 10mL W or 3g v ial with 15mL W
IV Injection 3-5 minutes
(A clear, light y ellow to amber solution should be obtained af ter shaking)
Reconstitute the contents of the v ial as f or IV injection
IV Infusion 15 to 30 min
Further dilute 1g or 2g doses with a minimum of 50mL NS or G and 75ml f or a 3g dose
Ceftazidime Giv e a loading dose, f ollowed by a continuous inf usion ov er 24 hours.
Continuous IV Reconstitute the contents of the v ial as f or IV injection 24 hours
infusion
Further dilute the dose with NS or G a minimum of 100mL f or a 4g (continuous inf usion) dose.
Reconstitute 500mg v ial with 1.5mL W, 1g v ial with 3mL W. For doses greater than 1g inject in two separate
Deep IM Injection
sites. May be reconstituted with 0.5% or 1% Lidocaine Hy drochloride Injection to reduce pain on injection
Reconstitute 250mg v ial with 2ml W, 750mg v ial with 6ml W and 1.5g v ial with 15ml W
IV Injection 3-5 minutes
Addition of water results in a y ellowish or a clear solution
IV Infusion Reconstitute the contents of the v ial as f or IV injection then dilute dose required to 50mL or 100mL with NS or G 30 minutes
Cefuroxime Reconstitute 250mg v ial with 1ml W, 750mg v ial with 3ml W, 1.5g v ial with 6ml W. Administer doses greater
Deep IM Injection than 750mg in 2 sites due to v olume
IV infusion with 1.5 g cef uroxime sodium constituted with 15 mL Water f or Injection may be added to metronidazole inf usion
30minutes
Metronidazole (500 mg/100 mL)

Ceftaroline IV infusion Reconstitute each 600mg v ial with 20 ml of W. Dilute the dose required in a minimum of 50mL NS or G 60 minutes

IV injection (P) To the 1g v ial add 9.2mL of W, NS or G. Maximum concentration 10% (100mg/ml) At least 1 minute

Chloramphenicol IV infusion Reconstitute as abov e then add to a minimum of 50ml G or NS 20-30 minutes

IM injection Add 1.7ml W or NS to 1g v ial (absorption can be slow and erratic)

400mg ov er at least 60 minutes

Ciprofloxacin IV Infusion only Ready diluted. Pref erably v ia central line or, if this is not possible, use large peripheral v ein
200mg ov er 30minutes

Reconstitute 500mg v ial with 10ml W then add to 250ml NS or G. Administer into a large peripheral v ein 60 minutes Central line ONLY –
Clarithromycin IV Infusion only 60 minutes
500mg/100ml
Reconstitute 600mg v ial with 10ml W or 1.2g v ial with 20ml W
IV Injection A transient pink colouration may dev elop during reconstitution. Reconstituted solutions are normally colourless 3-4 minutes
Co-amoxiclav or a pale straw colour
IV Infusion Reconstitute as per IV Injection then add 600mg to 50ml NS or 1.2g to 100ml NS 30 minutes

Doses up to 480mg – add to 100ml NS or G Doses 961-3840 – add to 500ml NS or G Doses up to 3840mg – ov er 60-
1. Central line ONLY in critical 1. 90 to 120 minutes
Doses 481-960mg – add to 250ml NS or G Doses 3841mg and abov e – add to 1L NS or G 90minutes
Co-trimoxazole IV Infusion only care areas - undiluted 2. 60 minutes
Use infusion pump. Pref erably via central line or, if this is not possible, use large peripheral v ein Doses 3841mg and abov e ov er a
2. Add each v ial to 75ml G
If v isible turbidity or cry stallisation appears at any time bef ore or during an inf usion, discard the mixture minimum of 2 hours.
Reconstitute 350mg v ial with 7ml NS and 500mg v ial with 10ml NS. Do not shake as this will cause f oaming of
IV Injection the product. The reconstituted solution ranges in colour f rom pale y ellow to light brown. 2 minutes
Daptomycin Pref erably v ia central line or, if this is not possible, use large peripheral v ein
Dilute the reconstituted solution with NS (ty pical v olume 50mL)
IV Infusion 30 minutes
Pref erably v ia central line or, if this is not possible, use large peripheral v ein
Reconstitute the contents of a 1g v ial with 10mL W or NS and add to a 50mL bag of NS
Ertapenem IV Infusion only 30 minutes
Reconstituted solutions of ertapenem range f rom colourless to pale y ellow
Doses less than 2g: 3-4 minutes
IV Injection Reconstitute 250 to 500mg in 5 to 10ml W or 1g in 15 to 20ml W
2g or more: 6-8 minutes
Flucloxacillin IV Infusion Reconstitute as f or IV injection then add to 100ml NS or G 30-60 minutes

IM Injection Reconstitute 250mg v ial with 1.5ml W and 500mg v ial with 2ml W

IV injection for
Can be given undiluted, or diluted with 10-20mL NS or G to aid slow administration.
Multiple daily Pref erably v ia central line or, if this is not possible, use large peripheral v ein 3-5 minutes
dosing
Gentamicin IV Infusion for
Dilute with 100mL NS or G
ONCE daily dosing Pref erably v ia central line or, if this is not possible, use large peripheral v ein Give over 60 minutes
(P)
IM injection No reconstitution or dilution required

250mg ov er at least 30min

Ready diluted. Use an inf usion pump
Levofloxacin IV infusion 500mg ov er at least 60min
Pref erably v ia central line or, if this is not possible, use large peripheral v ein
750mg ov er at least 90min
Doses of up to 1g only. Dilute each 500mg v ial with 10ml W and 1g with 20ml W
IV Injection Shake the reconstituted solution until clear and all the powder has dissolv ed Reconstituted solutions are clear, 5 minutes
Meropenem range f rom colourless to y ellow, and are f ree of particles.
Reconstitute as f or IV injection but can use W, NS or G.
IV Infusion (P) 15 to 30 minutes
Further dilute with 1g doses with 50ml or 2g dose with 100ml of NS or G

Metronidazole IV Infusion Ready diluted: 500mg in 100ml. (Compatible with cef uroxime -see above) At least 20 minutes
Reconstitute the v ial with 20ml W
Piperacillin and Reconstitute each 4.5g v ial with 20ml of W, NS or G. The reconstituted solutions may be f urther diluted to the
IV Infusion only 30 minutes or NS and administer v ia IV 5 minutes
tazobactam desired v olume (e.g. 50 ml to 150 ml) with NS, or G
injection
Af ter reconstitution add to 100mL
Reconstitute each 600mg v ial with the solv ent prov ided. Further dilute with 500ml NS or G 2-3 hours of diluent to giv e a concentration 30minutes
Rifampicin IV Infusion only
of 6mg in 1mL (unlicensed)

Reconstitute each v ial (200mg or 400mg) with 3.14 mL of W prov ided. Each 3ml of solution contains the
IV Injection 3-5 minutes
selected dose f rom the v ial. Only clear and y ellowish solutions should be used.
Teicoplanin IV Infusion Once reconstituted it may be f urther diluted with any suitable v olume of NS or G 30 minutes

IM Injection Reconstitute as f or IV injection

IV injection Reconstitute each 1g v ial with 10ml W to f orm a pale y ellow solution 3-4 minutes

Temocillin IV infusion Reconstitute as abov e and add to 50 to 150mL NS or G 30-40 minutes

IM injection Reconstitute 1g v ial with 2ml W ( lidocaine hy drochloride 0.5-1% may be used in place of W)

Reconstitute each 50mg v ial with 5.3 ml of NS or G. Each 5ml of the reconstituted solution giv es a 50mg dose.
Tigecycline IV Infusion only Add 50mg or 100mg dose to 100mL of NS or G. Tigecy cline should be y ellow/orange in colour once 30 to 60 minutes.
reconstituted.
Max. rate 10mg/min
Reconstitute 500mg v ial with 10ml W or 1g v ials with 20ml W. Doses of up to and including 500mg;
Doses ≤ 500mg: add to 100ml NS or G giv e ov er 60 minutes
Doses >500mg - ≤1.25g: add to 250ml NS or G. Doses of 1g; giv e ov er 120 minutes Central line ONLY
Vancomycin IV Infusion only Max. rate 10mg/min
Doses >1.25g: add to 500ml NS or G Doses of 1.5g; giv e ov er 180 minutes 500mg in 50ml or 1g in 100ml
Pref erably v ia central line or, if this is not possible, use large peripheral v ein Doses of 2g; giv e ov er at least 240
minutes.
Key: W = Water f or injection, NS = Sodium Chloride 0.9%, G = Glucose 5% (P) = Preferred Method.
rd rd
References: SPCs f rom www.emc.medicines.org.uk, IV guide (Medusa), UCL Injectable Medicines Administration guide (3 edition), Renal Drug Database, UKCPA minimum inf usion v olumes (3 Edition)
Penicillin Allergy:
Penicillin Allergy: Contraindicated 1. AVOID if serious penicillin allergy (e.g. anaphylaxis/angioedema) Penicillin Allergy: Considered Safe
2. USE WITH CAUTION if non-severe allergy and no alternative available