DESENSITIZATION PROTOCOLS See also, UMHHC Policy 07-01-017. Desensitization Policy for Drug Hypersensitivity for Inpatients for information regarding dosing intervals, infusion times, IV access requirements and monitoring. CONTENTS Amiodarone Ampicillin Ampicillin/Sulbactam Aspirin Atovaquone Aztreonam Cefazolin Cefepime Ceftazidime Ceftriaxone Ciprofloxacin Clopidogrel Levofloxacin Linezolid Meropenem Metronidazole Nafcillin Penicillin G Piperacillin/Tazobactam Tigecycline Vancomycin
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DESENSITIZATION PROTOCOLS - Michigan MedicineDESENSITIZATION PROTOCOLS See also, UMHHC Policy 07-01-017.Desensitization Policy for Drug Hypersensitivity for Inpatients for information
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DESENSITIZATION PROTOCOLS
See also, UMHHC Policy 07-01-017. Desensitization Policy for Drug Hypersensitivity for Inpatients for information regarding dosing intervals, infusion times, IV access requirements and monitoring.
12 (cumulative 300 mg) 150 mg 100 mL Bag 1 (1.5 mg/mL)
Note: Doses should be given 30 minutes apart
Bag Concentration
1. Remove 13 mL out of 100 mL D5W bag
2. Inject 150 mg/3 mL of amiodarone into 100 mL D5W (Bag #1) 1.5 mg/mL
3. Remove 12 mL out of 100 mL D5W bag
4. Inject 100 mg/2 mL of amiodarone into 100 mL D5W (Bag #2) 1 mg/mL
5. Remove 11 mL out of 100 mL D5W Bag #2
6. Inject 1 mL of Bag #1 into 100 mL D5W (Bag #3) 0.01 mg/mL
Page 3 of 26
Ampicillin
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS
Vial Concentration
1. Dilute 1 g AMPICILLIN vial with 9.5 mL SW, label vial #1 100 mg/mL
2. 0.1 mL of vial 1 plus 9.9 mL SW into an empty vial, label vial #2 1 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial, label vial #3 0.01 mg/mL
STEP 2: PREPARE IV DOSES Goal dose 1 g:
Dose # Dose Volume Vial #
1 0.01 mg 1 mL #3 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL #2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 3 mg 3 mL
7 5 mg 5 mL
8 10 mg 0.1 mL #1 (100 mg/mL)
9 30 mg 0.3 mL
10 50 mg 0.5 mL
11 100 mg 1 mL
12 300 mg 3 mL
13 500 mg 5 mL
Goal dose 2 g:
Dose # Dose Volume Vial #
1 0.01 mg 1 mL #3 (0.01 mg/mL)
2 0.03 mg 3 mL
3 0.05 mg 5 mL
4 0.1 mg 0.1 mL #2 (1 mg/mL)
5 0.3 mg 0.3 mL
6 0.5 mg 0.5 mL
7 1 mg 1 mL
8 3 mg 3 mL
9 5 mg 5 mL
10 10 mg 0.1 mL #3 (100 mg/mL
11 30 mg 0.3 mL
12 50 mg 0.5 mL
13 100 mg 1 mL
14 300 mg 3 mL
15 500 mg 5 mL
16 1 g Add-Vantage 1 g Add-Vantage vial assembled with 50 mL NS
Page 4 of 26
Ampicillin/Sulbactam
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS
Vial Concentration
1. Dilute 3 g Unasyn vial with 6.4 mL NS, label vial #1 375 mg/mL
2. 4 mL of vial 1 plus 11 mL NS into an empty vial, label vial #2 100 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL NS into an empty vial, label vial #3 1 mg/mL
4. 0.1 mL of vial 3 plus 9.9 mL NS into an empty vial, label vial #4 0.01 mg/mL
STEP 2: PREPARE IV DOSES Goal 1.5 g
Dose # Dose Volume Vial #
1 0.015 mg 1.5 mL 4 (0.01 mg/mL) 2 0.03 mg 3 mL
3 0.15 mg 0.15 mL 3 (1 mg/mL)
4 0.3 mg 0.3 mL
5 1.5 mg 1.5 mL
6 3 mg 3 mL
7 4.5 mg 4.5 mL
8 15 mg 0.15 mL 2 (100 mg/mL)
9 30 mg 0.3 mL
10 45 mg 0.45 mL
11 150 mg 1.5 mL
12 300 mg 3 mL
13 450 mg 4.5 mL
14 cumulative 1.5 g 500 mg 1.33 mL 1 (375 mg/mL)
Goal 3 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 4 (0.01 mg/mL)
2 0.03 mg 3 mL
3 0.1 mg 0.1 mL 3 (1 mg/mL)
4 0.3 mg 0.3 mL
5 1 mg 1 mL
6 3 mg 3 mL
7 10 mg 0.1 mL 2 (100 mg/mL)
8 30 mg 0.3 mL
9 100 mg 1 mL
10 300 mg 3 mL
11 1 g 2.67 mL 1 (375 mg/mL)
12 cumulative 3 g 1.5 g Add-Vantage 1.5 g Add-Vantage assembled with 50 mL NS
Page 5 of 26
ASPIRIN
STEP 1: ADMINISTER ASPIRIN DOSES USING ASPIRIN TABLETS
Dose # Dose Dosage Form
1 20.25 mg ¼ of 81 mg tab
2 40.5 mg ½ of 81 mg tab
3 40.5 mg ½ of 81 mg tab
4 81 mg 81 mg tab
5 121.5 mg 1 ½ 81 mg tab
6 202.5 mg 2 ½ 81 mg tab
7 325 mg 325 mg tab
Notes: Doses are to be given orally Doses should be given 90 – 180 minutes apart Patient must not react to a dose before moving on to an escalating dose Reference: White AA, Stevenson DD, Woessner KM, et al. Approach to patients with aspirin hypersensitivity and acute cardiovascular emergencies. Allergy Asthma Proc. 34:138-142, 2013.
Page 6 of 26
Atovaquone Oral Suspension (150 mg/mL)
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS
Vial Concentration
1. 1 mL of stock suspension (150 mg/mL) mixed with 14 mL SW, labeled #1 10 mg/mL
2. 1 mL of vial #1 plus 9 mL SW into an empty vial, labeled #2 1 mg/mL
3. 1 mL of vial #2 plus 9 mL SW into an empty vial, labeled #3 0.1 mg/mL
STEP 2: PREPARE PO DOSES Goal 750 mg
Dose # Dose Volume Vial #
1 0.1 mg 1 mL 3 (0.1 mg/mL) 2 0.3 mg 3 mL
3 0.5 mg 5 mL
4 1 mg 1 mL 2 (1 mg/mL)
5 3 mg 3 mL
6 5 mg 5 mL
7 10 mg 1 mL 1 (10 mg/mL) 8 30 mg 3 mL
9 50 mg 5 mL
10 100 mg 0.67 mL Stock suspension (150 mg/mL)
11 500 mg 3.33 mL
Goal 1.5 g
Dose # Dose Volume Vial #
1 0.1 mg 1 mL 3 (0.1 mg/mL) 2 0.3 mg 3 mL
3 0.5 mg 5 mL
4 1 mg 1 mL 2 (1 mg/mL)
5 3 mg 3 mL
6 5 mg 5 mL
7 10 mg 1 mL 1 (10 mg/mL) 8 30 mg 3 mL
9 50 mg 5 mL
10 100 mg 0.67 mL Stock suspension (150 mg/mL)
11 500 mg 3.33 mL
12 750 mg 5 mL
Page 7 of 26
Aztreonam
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS
Vial Concentration
1. Dilute 1 g AZTREONAM vial with 10 mL SW. Label as vial #1. 100 mg/mL
2. 0.1 mL of vial 1 plus 9.9 mL SW into an empty vial, labeled #2 1 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial, labeled #3 0.01 mg/mL
STEP 2: PREPARE IV DOSES Goal dose 1 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 3 mg 3 mL
7 5 mg 5 mL
8 10 mg 0.1 mL 1 (100 mg/mL)
9 30 mg 0.3 mL
10 50 mg 0.5 mL
11 100 mg 1 mL
12 300 mg 3 mL
13 500 mg 5 mL
Goal dose 2 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.1 mg/mL)
2 0.03 mg 3 mL
3 0.05 mg 5 mL
4 0.1 mg 0.1 mL 2 (1 mg/mL)
5 0.3 mg 0.3 mL
6 0.5 mg 0.5 mL
7 1 mg 1 mL
8 3 mg 3 mL
9 5 mg 5 mL
10 10 mg 0.1 mL 1 (100 mg/mL)
11 30 mg 0.3 mL
12 50 mg 0.5 mL
13 100 mg 1 mL
14 300 mg 3 mL
15 500 mg 5 mL
16 1 g 1 g vial in 50 mL
Corrected August 7, 2013.
Page 8 of 26
Cefazolin
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS
Vial Concentration
1. Dilute 1 g CEFAZOLIN vial with 9.6 mL SW, label vial #1 100 mg/mL
2. 0.1 mL of vial 1 plus 9.9 mL SW into an empty vial, labeled #2 1 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial , labeled #3 0.01 mg/mL
STEP 2: PREPARE IV DOSES Goal dose 500 mg
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 5 mg 5 mL
7 10 mg 0.1 mL 1 (100 mg/mL)
8 30 mg 0.3 mL
9 50 mg 0.5 mL
10 100 mg 1 mL
11 300 mg 3 mL
Goal dose 1 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 3 mg 3 mL
7 5 mg 5 mL
8 10 mg 0.1 mL 1 (100 mg/mL)
9 30 mg 0.3 mL
10 50 mg 0.5 mL
11 100 mg 1 mL
12 300 mg 3 mL
13 500 mg 5 mL
Page 9 of 26
Cefazolin, continued Goal dose 2 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.03 mg 3 mL
3 0.05 mg 5 mL
4 0.1 mg 0.1 mL 2 (1 mg/mL
5 0.3 mg 0.3 mL
6 0.5 mg 0.5 mL
7 1 mg 1 mL
8 3 mg 3 mL
9 5 mg 5 mL
10 10 mg 0.1 mL 1 (100 mg/mL)
11 30 mg 0.3 mL
12 50 mg 0.5 mL
13 100 mg 1 mL
14 300 mg 3 mL
15 500 mg 5 mL
16 1 g 1 g Add-Vantage in 50 mL
Page 10 of 26
Cefepime
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS
Vial Concentration
1. Dilute 1 g CEFEPIME vial with 10 mL SW, label vial #1 100 mg/mL
2. 0.1 mL of vial 1 plus 9.9 mL SW into an empty vial, labeled #2 1 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial, labeled #3 0.01 mg/mL
STEP 2: PREPARE IV DOSES Goal dose 1 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 3 mg 3 mL
7 5 mg 5 mL
8 10 mg 0.1 mL 1 (100 mg/mL)
9 30 mg 0.3 mL
10 50 mg 0.5 mL
11 100 mg 1 mL
12 300 mg 3 mL
13 500 mg 5 mL
Goal dose 2 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.03 mg 3 mL
3 0.05 mg 5 mL
4 0.1 mg 0.1 mL 2 (1 mg/mL)
5 0.3 mg 0.3 mL
6 0.5 mg 0.5 mL
7 1 mg 1 mL
8 3 mg 3 mL
9 5 mg 5 mL
10 10 mg 0.1 mL 1 (100 mg/mL)
11 30 mg 0.3 mL
12 50 mg 0.5 mL
13 100 mg 1 mL
14 300 mg 3 mL
15 500 mg 5 mL
16 1 g over 30 min Mini-bag plus or Add-Ease
Page 11 of 26
Ceftazidime
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS
Vial Concentration
1. Dilute 1 g CEFTAZIDIME vial with 10 mL SW, label vial #1 100 mg/mL
2. 0.1 mL of vial 1 plus 9.9 mL SW into an empty vial, labeled #2 1 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial, labeled #3 0.01 mg/mL
STEP 2: PREPARE IV DOSES Goal dose 500 mg
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 5 mg 5 mL
7 10 mg 0.1 mL 1 (100 mg/mL)
8 30 mg 0.3 mL
9 50 mg 0.5 mL
10 100 mg 1 mL
11 300 mg 3 mL
Goal dose 1 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 3 mg 3 mL
7 5 mg 5 mL
8 10 mg 0.1 mL 1 (100 mg/mL)
9 30 mg 0.3 mL
10 50 mg 0.5 mL
11 100 mg 1 mL
12 300 mg 3 mL
13 500 mg 5 mL
Page 12 of 26
Ceftazidime, continued
Goal dose 2 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.03 mg 3 mL
3 0.05 mg 5 mL
4 0.1 mg 0.1 mL 2 (1 mg/mL)
5 0.3 mg 0.3 mL
6 0.5 mg 0.5 mL
7 1 mg 1 mL
8 3 mg 3 mL
9 5 mg 5 mL
10 10 mg 0.1 mL 1 (100 mg/mL)
11 30 mg 0.3 mL
12 50 mg 0.5 mL
13 100 mg 1 mL
14 300 mg 3 mL
15 500 mg 5 mL
16 1 g Add-Vantage
Page 13 of 26
Ceftriaxone
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS
Vial Concentration
1. Dilute 1 g CEFTRIAXONE vial with 9.6 mL SW, label vial #1 100 mg/mL
2. 0.1 mL of vial 1 plus 9.9 mL SW into an empty vial, labeled #2 1 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial, labeled #3 0.01 mg/mL
STEP 2: PREPARE IV DOSES Goal dose 1 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 3 mg 3 mL
7 5 mg 5 mL
8 10 mg 0.1 mL 1 (100 mg/mL)
9 30 mg 0.3 mL
10 50 mg 0.5 mL
11 100 mg 1 mL
12 300 mg 3 mL
13 500 mg 5 mL
Goal dose 2 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.03 mg 3 mL
3 0.05 mg 5 mL
4 0.1 mg 0.1 mL 2 (1 mg/mL)
5 0.3 mg 0.3 mL
6 0.5 mg 0.5 mL
7 1 mg 1 mL
8 3 mg 3 mL
9 5 mg 5 mL
10 10 mg 0.1 mL 3 (100 mg/mL)
11 30 mg 0.3 mL
12 50 mg 0.5 mL
13 100 mg 1 mL
14 300 mg 3 mL
15 500 mg 5 mL
16 1 g Add-Vantage
Page 14 of 26
Ciprofloxacin
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS
Vial Concentration
1. Inject 0.5 mL Cipro (2 mg/mL) plus 9.5 mL D5W into an empty vial labeled #1 0.1 mg/mL
2. 1 mL of vial 1 plus 9 mL D5W into an empty vial labeled #2 0.01 mg/mL
3. 1 mL of vial 2 plus 9 mL D5W into an empty vial labeled #3 0.001 mg/mL
STEP 2: PREPARE IV DOSES Goal dose 400 mg
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 2 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 1 mL 1 (0.1 mg/mL)
4 0.5 mg 5 mL
5 1 mg 0.5 mL Bag (2 mg/mL)
6 5 mg 2.5 mL
7 10 mg 5 mL
8 20 mg 10 mL
9 50 mg 25 mL
10 100 mg 50 mL
11 200 mg over 60 min 200 mg premix bag
Page 15 of 26
CLOPIDOGREL
STEP 1: PHARMACY - PREPARE AND LABEL SERIAL DILUTION SOLUTIONS
Directions Concentration
1. Triturate 1 clopidogrel 75 mg tablet into a fine powder. Transfer powder to a 100 mL graduated cylinder. Rinse remaining powder in mortar with sterile water for irrigation and transfer to graduate. Add q.s. to 25 mL with sterile water for irrigation. Label graduate solution #1
3 mg/mL
2. Transfer 1 mL of clopidogrel 3 mg/mL solution to a new graduated cylinder plus 29 mL sterile water for irrigation. Label as solution #2
0.1 mg/mL
Goal dose 75 mg (please note all doses solution)
Dose # Dose Volume Vial #
1 0.02 0.2 mL 2 (0.1 mg/mL)
2 0.05 0.5 mL
3 0.15 1.5 mL
4 0.5 5 mL
5 1.5 0.5 mL 1 (3 mg/mL)
6 5 1.7 mL
7 15 5 mL
8 45 15 mL
Notes: Doses are to be given orally Doses should be given 30 minutes apart Initiate 75 mg clopidogrel 24 hours later. Reference: Sanchez-Lopez J, Munoz-Cano R, Bartra A, et al. Desensitization to clopidogrel: a growing need. Allergy. 65 (2010); 274-280.
Page 16 of 26
Levofloxacin
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS
Vial Concentration
1. Inject 1 mL LEVOFLOXACIN (5 mg/mL) plus 9 mL SW 0.5 mg/mL
2. 1 mL of vial 1 plus 9 mL SW into an empty vial, labeled #2 0.05 mg/mL
3. 1 mL of vial 2 plus 9 mL SW into an empty vial, labeled #3 0.005 mg/mL
STEP 2: PREPARE IV DOSES Goal dose 500 mg
Dose # Dose Volume Vial #
1 0.01 mg 0.2 mL 2 (0.05 mg/mL)
2 0.05 mg 1 mL
3 0.1 mg 2 mL
4 0.5 mg 1 mL 1 (0.5 mg/mL)
5 1 mg 2 mL
6 5 mg 1 mL Bag (5 mg/mL)
7 10 2 mL
8 30 mg 6 mL
9 50 mg 10 mL
10 100 mg 20 mL
11 300 mg over 60 minutes 60 mL
Goal dose 750 mg
Dose # Dose Volume Vial #
1 0.01 mg 0.2 mL 2 (0.05 mg/mL)
2 0.05 mg 1 mL
3 0.1 mg 2 mL
4 0.5 mg 1 mL 1 (0.5 mg/mL)
5 1 mg 2 mL
6 5 mg 1 mL Bag (5 mg/mL)
7 10 mg 2 mL
8 25 mg 5 mL
9 50 mg 10 mL
10 75 mg 15 mL
11 100 mg 20 mL
12 500 mg over 60 minutes 500 mg premix bag
Page 17 of 26
LINEZOLID
STEP 1: PHARAMCY - PREPARE AND LABEL SERIAL DILUTIONS
Note: Infuse doses 1-12 over five minutes and infuse doses 13-14 over fifteen minutes; wait ten minutes between each dose Reference: Bagwell AD, Stollings JL, White KD, et al. Linezolid desensitization for a patient with multiple medication hypersensitivity reactions. Ann Pharmacother. 2013; 47:e30.
Bag Concentration
1. Premixed bag of linezolid 600 mg/300 mL of D5W, label #1 2 mg/mL
2. 10 mL from bag 1 plus 90 mL D5W, labeled #2 0.2 mg/mL
3. 10 mL from bag 2 plus 90 mL D5W, labeled #3 0.02 mg/mL
Page 18 of 26
Meropenem
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS
Vial Concentration
1. Dilute 1 g MEROPENEM vial with 20 mL SW label vial #1 50 mg/mL
2. 0.2 mL of vial 1 plus 19.8 mL SW into an empty vial, labeled #2 0.5 mg/mL
3. 0.2 mL of vial 2 plus 19.8 mL SW into an empty vial, labeled #3 0.005 mg/mL
STEP 2: PREPARE IV DOSES Goal dose 500 mg
Dose # Dose Volume Vial #
1 0.01 mg 2 mL 3 (0.005 mg/mL)
2 0.05 mg 10 mL
3 0.1 mg 0.2 mL 2 (0.5 mg/mL)
4 0.5 mg 1 mL
5 1 mg 2 mL
6 5 mg 10 mL
7 10 0.2 mL 1 (50 mg/mL)
8 30 mg 0.6 mL
9 50 mg 1 mL
10 100 mg 2 mL
11 300 mg 6 mL
Goal dose 1 g
Dose # Dose Volume Vial #
1 0.01 mg 2 mL 3 (0.005 mg/mL)
2 0.05 mg 10 mL
3 0.1 mg 0.2 mL 2 (0.5 mg/mL)
4 0.5 mg 1 mL
5 1 mg 2 mL
6 3 mg 6 mL
7 5 mg 10 mL
8 10 mg 0.2 mL 1 (50 mg/mL)
9 30 mg 0.6 mL
10 50 mg 1 mL
11 100 mg 2 mL 1 (50 mg/mL)
12 300 mg 6 mL
13 500 mg 10 mL
Page 19 of 26
Meropenem, continued
Goal dose 2 g
Dose # Dose Volume Vial #
1 0.01 mg 2 mL 3 (0.005 mg/mL)
2 0.03 mg 6 mL
3 0.05 mg 10 mL
4 0.1 mg 0.2 mL 2 (0.5 mg/mL)
5 0.3 mg 0.6 mL
6 0.5 mg 1 mL
7 1 mg 2 mL
8 3 mg 6 mL
9 5 mg 10 mL
10 10 mg 0.2 mL 1 (50 mg/mL)
11 30 mg 0.6 mL
12 50 mg 1 mL
13 100 mg 2 mL
14 300 mg 6 mL
15 500 mg 10 mL
16 1 g Mini-Bag Plus or Add-Ease
Page 20 of 26
METRONIDAZOLE
STEP 1: PHARMACY - PREPARE AND LABEL SERIAL DILUTIONS
Bag/Vial Concentration
1. Use metronidazole 500 mg/100 mL pre-manufactured IV bag. Label as Bag #1. 5 mg/mL
2. 1 mL of Bag #1 plus 9 mL NS into an empty vial, labeled #2 0.5 mg/mL
3. 1 mL of vial #2 plus 9 mL NS into an empty vial, labeled #3 0.05 mg/mL
4. 1 mL of vial #3 plus 9 mL NS into an empty vial, labeled #4 0.005 mg/mL
Notes: Intravenous increments are administered at 15 minute intervals Infuse doses 1-2 over 10 minutes, doses 3-11 over 15 minutes, and dose 12 over 30 minutes Goal dose 2 g
Dose # Dose Volume Bag/Vial #
1 0.005 mg 1 mL 4 (0.005 mg/mL)
2 0.015 mg 3 mL
3 0.05 mg 1 mL 3 (0.05 mg/mL)
4 0.15 mg 3 mL
5 0.5 mg 1 mL 2 (0.5 mg/mL)
6 1.5 mg 3 mL
7 5 mg 1 mL
1 (5 mg/mL)
8 25 mg 5 mL
9 50 mg 10 mL
10 150 mg 30 mL
11 250 mg 50 mL
12 500 mg 100 mL Pre-manufactured 500 mg/100 mL bag 13 1 g 200 mL
14 Then follow scheduled interval 2 g dosing
Notes: Intravenous increments are administered at 15 minute intervals Infuse doses 1-2 over 10 minutes, doses 3-11 over 15 minutes, dose 12 over 30 minutes, and doses 13-14 over 60 minutes Reference: Pearlman MD, Yashar C, Ernst S, Solomon W. An incremental dosing protocol for women with severe vaginal trichomoniasis and adverse reactions to metronidazole. Am J Obstet Gynecol. 1996; 174;934-6.
Page 21 of 26
Nafcillin
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS
Vial Concentration
1. Dilute 1 g NAFCILLIN vial with 8.3 mL SW, label vial #1 100 mg/mL
2. 0.1 mL of vial 1 plus 9.9 mL SW into an empty vial, labeled #2 1 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial, labeled #3 0.01 mg/mL
STEP 2: PREPARE IV DOSES Goal dose 1 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 3 mg 3 mL
7 5 mg 5 mL
8 10 mg 0.1 mL 1 (100 mg/mL)
9 30 mg 0.3 mL
10 50 mg 0.5 mL
11 100 mg 1 mL
12 300 mg over 30 min 3 mL
13 500 mg over 30 min 5 mL
Goal dose 2 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.03 mg 3 mL
3 0.05 mg 5 mL
4 0.1 mg 0.1 mL 2 (1 mg/mL)
5 0.3 mg 0.3 mL
6 0.5 mg 0.5 mL
7 1 mg 1 mL
8 3 mg 3 mL
9 5 mg 5 mL
10 10 mg 0.1 mL 1 (100 mg/mL)
11 30 mg 0.3 mL
12 50 mg 0.5 mL
13 100 mg 1 mL
14 300 mg over 30 min 3 mL
15 500 mg over 30 min 5 mL
16 1 g over 30-60 min Add-Vantage
Page 22 of 26
Penicillin G
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS
Vial Concentration
1. Dilute 5,000,000 unit PENICILLIN G vial with 8 mL SW label vial #1 500,000 units/mL
2. 1 mL of vial 1 plus 9 mL SW into an empty vial, labeled #2 50,000 units/mL
3. 1 mL of vial 2 plus 9 mL SW into an empty vial, labeled #3 5,000 units/mL
4. 1 mL of vial 3 plus 9 mL SW into an empty vial, labeled #4 500 units/mL
5. 1 mL of vial 4 plus 9 mL SW into an empty vial, labeled #5 50 units/mL
6. 1 mL of vial 5 plus 9 mL SW into an empty vial, labeled #6 5 units/mL
STEP 2: PREPARE IV DOSES Goal dose 2.5 million units
Dose # Dose Volume Vial #
1 1 unit 0.2 mL 6 (5 units/mL)
2 5 units 1 mL
3 10 units 2 mL
4 50 units 1 mL 5 (50 units/mL)
5 100 units 2 mL
6 500 units 1 mL 4 (500 units/mL)
7 750 units 1.5 mL
8 1,000 units 2 mL
9 5,000 units 1 mL 3 (5,000 units/mL)
10 7,500 units 1.5 mL
11 10,000 units 2 mL
12 50,000 units 1 mL 2 (50,000 units/mL)
13 75,000 units 1.5 mL
14 100,000 units 2 mL
15 500,000 units 1 mL 1 (500,000 units/mL)
16 750,000 units 1.5 mL
17 1,000,000 units 2 mL
Page 23 of 26
Penicillin G, continued Goal dose 3 million units
Dose # Dose Volume Vial #
1 1 unit 0.2 mL 6 (5 units/mL)
2 5 units 1 mL
3 10 units 2 mL
4 50 units 1 mL 5 (50 units/mL)
5 100 units 2 mL
6 500 units 1 mL 4 (500 units/mL)
7 750 units 1.5 mL
8 1,000 units 2 mL
9 5,000 units 1 mL 3 (5,000 units/mL)
10 7,500 units 1.5 mL
11 10,000 units 2 mL
12 50,000 units 1 mL 2 (50,000 units/mL)
13 75,000 units 1.5 mL
14 100,000 units 2 mL
15 500,000 units 1 mL 1 (500,000 units/mL)
16 1,000,000 units 2 mL
17 1,250,000 units 2.5 mL
Goal dose 4 million units
Dose # Dose Volume Vial #
1 1 unit 0.2 mL 6 (5 units/mL)
2 5 units 1 mL
3 10 units 2 mL
4 50 units 1 mL 5 (50 units/mL)
5 100 units 2 mL
6 500 units 1 mL 4 (500 units/mL)
7 1,000 units 2 mL
8 5,000 units 1 mL 3 (5,000 units/mL)
9 10,000 units 2 mL
10 30,000 units 0.6 mL 2 (50,000 units/mL)
11 50,000 units 1 mL
12 100,000 units 2 mL
13 300,000 units 0.6 mL 1 (500,000 units/mL)
14 500,000 units 1 mL
15 750,000 units 1.5 mL
16 1,000,000 units 2 mL
17 1,250,000 units 2.5 mL
Page 24 of 26
Piperacillin/tazobactam (Zosyn)
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS
Vial Concentration
1. Dilute 3.375 g ZOSYN vial with 16.9 mL SW label vial #1 200 mg/mL
2. 5 mL of vial 1 plus 5 mL SW into an empty vial, labeled #2 100 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial, labeled #3 1 mg/mL
4. 0.1 mL of vial 3 plus 9.9 mL SW into an empty vial, labeled #4 0.01 mg/mL
The recommendations in this guide are meant to serve as treatment guidelines for use at Michigan Medicine facilities. If you are an individual experiencing a medical
emergency, call 911 immediately. These guidelines should not replace a provider’s professional medical advice based on clinical judgment, or be used in lieu of an
Infectious Diseases consultation when necessary. As a result of ongoing research, practice guidelines may from time to time change. The authors of these guidelines
have made all attempts to ensure the accuracy based on current information, however, due to ongoing research, users of these guidelines are strongly encouraged to
confirm the information contained within them through an independent source.
If obtained from a source other than med.umich.edu/asp, please visit the webpage for the most up-to-date document.
Page 26 of 26
Vancomycin
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS
Vial Concentration
1. Dilute 1 g VANCOMYCIN vial with 20 mL SW, label vial #1 50 mg/mL
2. 1 mL of vial 1 plus 9 mL SW into an empty vial, labeled #2 5 mg/mL
3. 1 mL of vial 2 plus 9 mL SW into an empty vial, labeled #3 0.5 mg/mL
4. 1 mL of vial 3 plus 9 mL SW into an empty vial, labeled #4 0.05 mg/mL