On-call scenario 1: Resolution

Last updated: Tuesday, November 26, 2019

What an on-call pharmacist could advise...

Since cefuroxime and magnesium sulphate appear to be physically incompatible, the two infusions cannot be administered through the same single lumen line. However, you can't just provide this information – you need to offer some practical advice for the midwife and her patient. She has already indicated that the patient was difficult to cannulate and so inserting another line might not be straightforward.

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In some situations, it might be suitable to temporarily discontinue a continuous intravenous infusion, to quickly give an intravenous injection or a very short infusion. In this scenario although the cefuroxime could be given as an intravenous injection over 3 to 5 minutes, the metronidazole would need to be given over at least 20 minutes. Any decision to stop magnesium sulphate for this length of time would need to be made by the consultant caring for the patient.

An alternative way forward might be to consider administering the antibiotics via a different route. It might be clinically acceptable to use the rectal route for the metronidazole and the intramuscular route for the cefuroxime, but these routes might not be as acceptable to the patient. Alternatively, the metronidazole infusion might be run with the magnesium sulphate (but bearing in mind the limitations of the compatibility data you have found), and then the cefuroxime given intramuscularly.

A final option might be to switch to a different antibiotic that could be given as an intravenous injection.

So, you have three practical options to discuss with the midwife.

Follow up

The next morning, ensure that you let the antenatal unit pharmacist know about the enquiry and the advice that you gave. Ask them to find out what course of action the midwife took so you can document the outcome and share your experience with your on-call colleagues.

If this scenario has made you a little concerned about answering a question like this when you're on-call, then why not look through the Injection compatibility tutorial to refresh your knowledge?

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