How to prepare an infusion of cefoperazone?

Cefoperazone Infusion Preparation

For intravenous administration, reconstitute cefoperazone powder with sterile water for injection or compatible diluent to achieve the desired concentration, typically 40 mg/mL for optimal stability, then further dilute in a compatible IV solution for infusion. 1

Reconstitution and Dilution Guidelines

Standard IV Preparation

• Reconstitute the cefoperazone powder vial with an appropriate volume of sterile water for injection, 0.9% sodium chloride, or 5% dextrose solution 1
• Target concentration for infusion is 40 mg/mL, which provides optimal stability at room temperature 1
• For a 2g dose, add approximately 50 mL of diluent to achieve this concentration 1

Administration Methods

Intermittent Infusion (Preferred)

• Administer 2g cefoperazone diluted in 50-100 mL of compatible solution over 15-30 minutes 1
• This method produces serum levels of 250-260 micrograms/mL 2
• Infusion times can range from 15 minutes to 2 hours depending on clinical situation 2

Bolus Injection

• Can be administered as rapid IV push over 3-5 minutes if necessary 2
• Produces immediate peak levels: 200 micrograms/mL for 1g, 275 micrograms/mL for 2g, and 518 micrograms/mL for 3g 2

Compatible Diluents

• 0.9% sodium chloride (normal saline) 1
• 5% dextrose in water (D5W) 1
• Lactated Ringer's solution 1

Stability Considerations

Storage Requirements

• Refrigerate reconstituted solutions at 5°C for maximum stability of 80 days 1
• At room temperature (25°C), stability is maintained for 80 days 1
• At 20°C, stability extends to 96 days 1

Important Stability Notes

• Cefoperazone demonstrates excellent stability compared to other cephalosporins 1
• The optimal dilution of 40 mg/mL balances stability with practical administration 1
• Solutions should be inspected visually for particulate matter before administration 1

Dosing Context

• Standard adult dose is 2-4g IV every 12 hours 1
• For hospital-acquired pneumonia: 4g IV every 12 hours 1
• Maximum daily dose is typically 8-12g divided into doses 1

Clinical Pearls

Phlebitis Risk

• Cefoperazone has a mild phlebitis risk (rating: 1), making it suitable for peripheral IV administration 1
• This is lower than many other antibiotics, reducing the need for central access 1

Unique Pharmacokinetic Properties

• Unlike other cephalosporins, cefoperazone is primarily eliminated through biliary excretion (60-70%) rather than renal excretion 2, 3, 4
• No dosage adjustment needed in renal failure, but adjustment required in severe hepatic dysfunction or biliary obstruction 3, 4
• Achieves exceptionally high biliary concentrations (675-6000 micrograms/mL), making it ideal for biliary tract infections 3

Administration Timing

• The first dose should be administered in a supervised setting with resuscitation equipment available 1
• Serum levels remain therapeutic (>2 micrograms/mL) for at least 12 hours after a 2g dose 2, 3