Salbec Caution For Usage

Instructions for Use/Handling: SALBEC (cefoperazone/ sulbactam) is available in 2.0g vials. (See Table 6.)

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For use, a 6.7 ml volume of diluent should be added, yielding a maximum final concentration of 125 mg/ml cefoperazone and 125 mg/ml sulbactam.
Cefoperazone/sulbactam has been shown to be compatible with water for injection, 5% dextrose, 0.9% normal saline, 5% dextrose in 0.225% saline, and 5% dextrose in normal saline at concentrations up to 125 mg cefoperazone and 125 mg sulbactam per ml.
Lactated Ringer's Solution: Sterile Water for Injection should be used for reconstitution (see Incompatibilities: Lactated Ringer's Solution as follows). A two step dilution is required using Sterile Water for Injection (previously shown in table) further diluted with Lactated Ringer's Solution to a sulbactam concentration of 5mg/ml (use 2 ml initial dilution in 50 ml or 4 ml initial dilution in 100 ml Lactated Ringer's Solution).
Lidocaine: Sterile Water for Injection should be used for reconstitution (see Incompatibilities: Lidocaine as follows).
For a concentration of cefoperazone of 250 mg/ml or larger, a two step dilution is required using Sterile Water for Injection further diluted with 2% lidocaine to yield solutions containing up to 125 mg cefoperazone and 125 mg sulbactam per ml in approximately a 0.5% lidocaine HCL solution.
Reconstitution and administration of the contents should be performed under suitable aseptic conditions.
The reconstituted solution must be clear, not coloured with no visible particulate matter. SALBEC vials are intended for single administration, any unused solution should be discarded.
Incompatibilities: Aminoglycosides: Sulbactam/cefoperazone solutions and aminoglycosides shall not be mixed, due to physical incompatibility. If combined therapy with sulbactam/cefoperazone and aminoglycosides is intended (see Combined therapy under Indications/Uses), this can be carried out via divided intermittent intravenous infusion, using separate intravenous catheter; the starting intravenous catheter shall be washed with appropriate solvent very well between the doses. It is also recommended, sulbactam/cefoperazone doses to be administered in the course of the day, as far as possible in time from the aminoglycosides' time of administration.
Lactated Ringer's Solution: Initial reconstitution with Lactated Ringer's Solution should be avoided since this mixture has been shown to be incompatible. However, a two step dilution process involving initial reconstitution in water for injection will result in a compatible mixture when further diluted with Lactated Ringer's Solution (see Instructions for Use/Handling: Lactated Ringer's Solution as previously mentioned).
Lidocaine: Initial reconstitution with 2% lidocaine HCl solution should be avoided since this mixture has been shown to be incompatible. However, a two step dilution process involving initial reconstitution in water for injection will result in a compatible mixture when further diluted with 2% lidocaine HCl solution (see Instructions for Use/Handling: Lidocaine as previously mentioned).
Furthermore, sulbactam/cefoperazone is not compatible with nicardipine, ondansetron, perfenzazin, promethazine, protamine, vinorelbine, filgrastim, amifostine.