Thrombophlebitis parenteral administration

Although cephalosporins are more toxic than penicillin, they are well tolerated. Parenteral injection may cause pain when given intramuscularly and may cause thrombophlebitis when given intravenously. The oral cephalosporin administration causes diarrhea by altering the gut ecology. Hypersensitivity reactions are caused and are similar to those of penicillins. Cephaloridine causes nephrotoxicity, but presently available cephalosporins have less renal toxicity. 

Intravenous administration of erythromycin into peripheral veins relatively commonly causes thrombophlebitis, although the lactobionate form of erythromycin may be less irritating to veins than other parenteral forms (11,12). In a prospective study of 550 patients with 1386 peripheral venous catheters, the incidence of phlebitis was 19% with antibiotics and 8.8% without erythromycin was associated with an increased risk (13). 

Infusion phlebitis presents a problem in parenteral nutrition. Various alternative techniques of administration have been compared in order to identify means of countering this problem (9). Mechanical trauma appears to be a causative factor it can be reduced by hmiting the time of exposure of the vein wall to nutrient infusion and by minimizing the amount of prosthetic material within the vein (10). This is hkely to be even more important in small veins. In one study the addition of heparin (500 U/1) and hydrocortisone (5 micrograms/ml) significantly reduced the risk of thrombophlebitis from 0.43 to 0.11... 

Oral and parenteral do.sagc forms of ganciclovir are available. but oral bioavailability is poor. Only 5 to IO r of an oral dose is absorbed. Intravenous administration is preferable. More than 90% of the unchanged drug is excreted in the urine. Ganciclovir for injection is available as a lyophili/ed sodium salt for reconstitution in normal saline. S% dextrose in water, or lactated Ringer s solution. These. solutions are stningly alkaline (pH 11) and must be administered by slow, constant, intravenous infusion to avoid thrombophlebitis. 

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