Ceftaroline is a powerful antibiotic requiring a specific and careful process for preparation and administration. Healthcare professionals must follow aseptic techniques meticulously to ensure a sterile and effective infusion. This guide details the steps for reconstituting and diluting the medication, followed by the IV infusion process.
Preparation of Ceftaroline for Administration
Ceftaroline is supplied as a sterile, pale yellow to light yellow powder in single-use glass vials and must be reconstituted before use. The following steps outline the standard procedure:
Step 1: Aseptic Reconstitution
Aseptic technique should be used when reconstituting ceftaroline powder. Add a compatible diluent, such as Sterile Water for Injection, 0.9% Sodium Chloride Injection, 5% Dextrose Injection, or Lactated Ringer's Injection, to the vial. Gently mix until the powder is fully dissolved, which typically takes under two minutes.
Step 2: Visual Inspection
After reconstitution, the solution should be clear, pale yellow to dark yellow, and free of particles. Discard the solution if it is discolored or contains particulate matter.
Step 3: Further Dilution
The reconstituted solution needs further dilution in an infusion bag containing a compatible solution. If sterile water was used for reconstitution, a different compatible solution is needed for this step.
Step 4: Storage and Handling
From the start of reconstitution to the completion of IV preparation, the total time should not exceed 30 minutes. The final diluted solution can be stored for a limited time at room temperature or under refrigeration (2–8°C). Do not mix ceftaroline with other medications or add it to solutions containing other drugs.
Intravenous Infusion Process
Once prepared, a healthcare professional administers the ceftaroline infusion according to strict protocols.
Infusion Rate and Duration
The infusion duration varies by age: Adults (≥ 18 years) and pediatric patients (≥ 2 months) typically receive the infusion over 5 to 60 minutes, while infants (< 2 months) require 30 to 60 minutes.
Administration Protocol
The prepared IV bag is connected to the administration set and the infusion is started. The antibiotic is usually given at regular intervals, depending on the patient's condition and kidney function. It is important to complete the entire course of treatment as prescribed to prevent infection recurrence and antibiotic resistance.
Dosage Adjustments for Renal Impairment
Renal function significantly impacts ceftaroline dosage because the kidneys primarily eliminate the drug. Dosage adjustments are necessary for adult patients with impaired renal clearance. The following table provides general information regarding potential dosage adjustments for adults, but specific dosages must be determined by a healthcare professional based on individual patient assessment:
| Estimated Creatinine Clearance (CrCl) | General Consideration for Dosage Adjustment (Adults) |
|---|---|
| > 50 mL/min | No dose adjustment typically required |
| 31 to 50 mL/min | Dosage reduction is usually necessary |
| 15 to 30 mL/min | Further dosage reduction is typically necessary |
| End-Stage Renal Disease (< 15 mL/min), including hemodialysis | Significant dosage reduction and timing adjustments related to dialysis are generally required |
It's important to note that dosing recommendations for pediatric patients with renal impairment are not well-established. Close monitoring and individualized dosing are required.
Precautions and Monitoring
Several precautions are necessary when administering ceftaroline:
- Allergy History: Monitor patients with a history of serious allergic reactions to penicillin or other beta-lactam antibiotics due to potential cross-sensitivity.
- Hypersensitivity Reactions: Stop the infusion immediately if an allergic reaction, such as anaphylaxis, occurs.
- Clostridioides difficile: Ceftaroline use can lead to C. difficile-associated diarrhea (CDAD). Evaluate patients with severe diarrhea for CDAD.
- Neurotoxicity: Rare cases of neurological adverse reactions have been reported, especially in renally impaired patients without appropriate dose adjustment.
- False Positive Coombs' Test: Ceftaroline can cause a positive direct Coombs' test.
Conclusion
Administering ceftaroline involves specific preparation and controlled IV infusion to ensure effectiveness and safety. Dosage requires adjustment based on renal function, and vigilant monitoring for side effects and allergies is crucial. Patients should be advised to complete the full treatment course as prescribed by their healthcare provider.
For more detailed prescribing information, consult the official FDA package insert for Teflaro [https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/200327s015lbl.pdf].
