Compounding Parenteral Nutrition: Options and Updates

The compounding of “sterile” products has made headlines in the news in the United States over the last several years, due the lack of sterile conditions in a compounding pharmacy causing an outbreak of fungal meningitis [1]. Although USP Chapter <797> was released in 2008 and outlines in detail procedures needed to keep pharmacies sterile, these lapses in sterility still occurred [2]. However, the state governments were primary responsible for enforcing these procedures until recently [1]. In 2013, the Unites States Congress broadened laws by passing the Drug Quality and Security Act of 2013, which gave the federal government the power to enforce USP Chapter <797> for compounding pharmacies. In addition, USP Chapter <797> is undergoing updates, and all practitioners in the field should be aware of the changes that are coming in the future [3]. The field of parenteral nutrition has changed over the last few years as well, giving options such as premixed bags with multiple chambers.