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Made for the shade

One of my colleagues says that I.V. aminophylline needs to be protected from light. I was surprised to hear this because it's supplied in a clear vial and we've never used any special precautions during administration to protect it from light. Could you please clarify this for me?-J.N., MISS.

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Our pharmacist consultant thinks this is a great question. Many medications do need to be protected from light, and you're correct that many of these medications are packaged in amber vials. For example, diphenhydramine, furosemide, ketorolac, and prochlorperazine are packaged in amber vials to protect the contents from light.


But some medications that aren't packaged in amber vials, including aminophylline, should be protected from light until the drug is prepared for administration. Other examples include ceftriaxone, alteplase, and amiodarone. Keep these drugs in their cartons before use.


A few medications, such as sodium nitroprusside, are especially sensitive to light. With these, the manufacturer recommends that the diluted product be immediately wrapped in opaque material before the pharmacy dispenses it. The infusion drip chamber and the tubing don't need to be covered.1


A classic study demonstrated that aminophylline injection retained its potency for at least 8 weeks under exposure to fluorescent light.2 For this reason, although it's a good idea to protect aminophylline injection from light in storage, it doesn't need to be protected from light while it's being administered to a patient.



1. Hospira, Inc. Nitropress (sodium nitroprusside) injection, solution. 2006. [Context Link]


2. Boak LR. Aminophylline stability. Can J Hosp Pharm. 1987;40:155. [Context Link]



Ah, there's the rub

When a patient observed me performing hand hygiene using an alcohol-based hand rub, she said, "That's why there's MRSA." Is there any evidence to support the idea that use of alcohol-based hand sanitizers contributes to antibiotic resistance?-K.H., PA.


Alcohol-based hand sanitizers or rubs are effective against methicillin-resistant Staphylococcus aureus (MRSA) and most other bacterial pathogens, and they don't contribute to antibiotic resistance.1 While recently some household antimicrobial soaps have been linked in the lab setting to antibiotic resistance, no studies have implicated alcohol-based hand rubs in antibiotic resistance.


The reason is simple: The bactericidal mechanisms for alcohol-based hand rubs are entirely different from those of antibiotics. Bactericidal antibiotics can kill bacteria through various mechanisms of action, including interference with bacterial wall synthesis. They kill bacteria without killing nonbacterial cells. Alcohol's antimicrobial mechanism of action is described as nonspecific, usually by denaturation and coagulation of proteins. Alcohol evaporates readily after topical application, so no antiseptic residue is left on the skin. Consequently, the development of resistance as a result of healthcare antiseptic use is unlikely.


Alcohol applied topically doesn't discriminate in the cells it kills. Anyone who has inappropriately applied alcohol to a wound knows that it causes instant, dramatic pain; the pain occurs as cells die when they come into contact with the alcohol. The cells of exposed intact skin are already dead, so the skin's living cells aren't damaged by alcohol-based hand rubs.


Antibacterial soaps (sometimes called antimicrobial or antiseptic soaps) used for hand hygiene that have been implicated in antibiotic resistance in the lab setting are mostly products that include triclosan. Triclosan is an antibacterial chemical commonly added to consumer products. In lab studies, it's been shown to disrupt hormones and can encourage the growth of antibiotic-resistant bacteria. The FDA has begun to restrict the inclusion of triclosan in household soaps that claim antimicrobial activity.


Inform patients and families that routinely using alcohol-based hand rubs for hand hygiene is in fact one of the best ways to stop the spread of MRSA and other pathogens.



1. Boyce JM, Pittet D Healthcare Infection Control Practices Advisory Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Recomm Rep. 2002;51(RR-16):1-45. [Context Link]