You receive the following order: Azithromycin 500 mg IV over 60 minutes. You loo

Question

You receive the following order: Azithromycin 500 mg IV over 60 minutes. You look in the Handbook on Injectable Drugs and find the following information: Azithromycin - AHFS 8: 12.12.92 Products- Azithromycin is available as a powder in vials containing the equivalent of 500 mg of azithromycin along with citric acid and sodium hydroxide. The drug is packaged under vacuum^ . Reconstitute with 4.8 mL of sterile water for injection and shake until the drug is dissolved yielding a 100-mg/mL solution^ . Because of the vacuum, a non-automated syringe is recommended to ensure that the correct amount of diluent is added.^ pH- From 6.4 to 6.6. Trade Name(s)- Administration - Azithromycin is administered only by intravenous infusion over not less than 60 minutes after dilution to a concentration of 1 to 2 mg/mL in a compatible infusion solution. It should not be given by any other routes. Stability-Intact values should be stored at room temperature. The reconstituted solution is stable for 24 hours at room temperature. a. To what volume should azithromycin be diluted to administer this dose? b. At what rate should the diluted azithromycin be administered in mL/hr? c. If this dose was to be administered via gravity flow using an IV set calibrated to deliver 20 drops/mL. What is the drip rate in drops/minute you would recommend?

Explanation / Answer

(a) As initial concentration is = 100 mg/mL in 4.8 mL solution

Required concentration is = 1-2 mg/mL

Hence, initial amount of Azithromycin available in 4.8 mL solution is = 100 mg/mL x 4.8 mL

                                                                                                                 = 480 mg

Hence, to make concentration 1-2 mg/Ml required volume of dilutant is:

Conc = mass / volume

volume = mass/ conc

             = 480 /1-2

             = 240 - 480 mL

Hence, this 100 mg/mL solution must be diluted to 240 - 480 mL solution with dilutant.

(b) Now, drug is diluted to 240 -480 mL and whole must be injected in time not less than 60 minutes.

Or maximum rate of injection must be 480 mL/hr. or if diluted to 240 then 240 mL /hr. This is maximum rate for different level of dilutions, drug must be injected at a rate lesser than this only.

(c) Given callibration = 20 drops/mL

Amount of diluted drug to be injected = 240 - 480 mL

total number of drops = 20 x (240 or 480) = 4800 or 9600 drops

time for injection = 60 min minimun.

hence, maximum drop rate for 4800 drops = 4800/60 = 80 drops per minute

hence, maximum drop rate for 9600 drops = 9600/60 = 160 drops per minute

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