Ribavirin ampoule formulation remains a major challenge in managing Lassa fever disease. Lassa fever is an endemic viral hemorrhagic fever in the West Africa subregion, which has high-dose ribavirin as the standard of care. The high-dose therapy required makes the 200 mg/ml ampoule dosing of ribavirin a daunting task to administer, especially during disease outbreaks. This commentary highlights the challenges and makes a passionate call for vial dosage adjustment to fit the high-dose requirement of Lassa fever disease.

OBJECTIVE: The aim of this study was to determine the level of glass particle contamination from medical ampoules during breakage in nursing practice and their removal by filtration.
METHODS: Glass medical ampoules were broken-open as instructed and contamination was assessed microscopically.
METHODS: Three types of medial ampoules (A, B, C) were used. Dispensation of contents was carried out using 21 or 22 G needles, with and without syringe-filters. Particles were determined by light microscopy. This study was conducted between April 2018 and January 2020.
RESULTS: Glass particles of 0.94-90.70 µm were detected in 94% of all samples. There were 48, 162 and 201 glass particles in groups, A, B and C, respectively. Filtration had no effect in group A but was effective up to 85% in the other groups.
CONCLUSIONS: This study confirms that ampoule contents are contaminated with glass particles during the opening procedure, which varies with make and content. Syringe-filter use can be up to 85% effective in their removal.
CONCLUSIONS: Use of syringe-filter can decrease glass particle contamination up to 85%. Innovative nursing studies are needed to minimize or completely avoid particule contamination.

The rapid increase in vapor pressure of liquid HF with temperature has been used in a rupture-disk-ampoule technique for mixing HF with materials under anhydrous conditions. At room temperature where HF has a vp near 1.4 atm, the disk with a rupture limit near 10 atm confines the acid. At higher temperatures, 100 and 150 °C, where the internal pressure of HF in the ampoule is 10 and 30 atm, respectively, the disk is ruptured and the acid is released. The construction of the ampoule from platinum and reuseable platinum-iridium parts; the details of the filling, sealing and weighing; and its use for anhydrous addition of HF to other materials in a closed vessel are described.

In this study, causes of collapsed bacterial cultures in glass ampoules observed after freeze-drying were investigated as well as the influence of collapse on residual moisture content (RMC) and viability. Also, the effect of heat radiation and post freeze-drying treatments on the RMC was studied. Cake morphologies of 21 bacterial strains obtained after freeze-drying with one standard protocol could be classified visually into four major types: no collapse, porous, partial collapse, and collapse. The more pronounced the collapse, the higher residual moisture content of the freeze-dried product, ranging from 1.53 % for non-collapsed products to 3.62 % for collapsed products. The most important cause of collapse was the mass of the inserted cotton plug in the ampoule. Default cotton plugs with a mass between 21 and 30 mg inside the ampoule did not affect the viability of freeze-dried Aliivibrio fischeri LMG 4414(T) compared to ampoules without cotton plugs. Cotton plugs with a mass higher than 65 mg inside the ampoule induced a full collapsed product with rubbery look (melt-back) and decreasing viability during storage. Heat radiation effects in the freeze-drying chamber and post freeze-drying treatments such as exposure time to air after freeze-drying and manifold drying time prior to heat sealing of ampoules influenced the RMC of freeze-dried products. To produce uniform batches of freeze-dried bacterial strains with intact cake structures and highest viabilities, inserted cotton plugs should not exceed 21 mg per ampoule. Furthermore, heat radiation effects should be calculated in the design of the primary drying phase and manifold drying time before heat sealing should be determined as a function of exposure time to air.

OBJECTIVE: Medication error can occur due to fault at any level starting from manufacturing until the administration to the patient. It can be difficult to read the drug name and other information from an ampoule, if there is poor contrast between the font color and background of the ampoule. Primary aim of this study was to evaluate the efficacy of the contrast color on the ampoule\'s label.
METHODS: The study was conducted in a randomized blinded manner at a tertiary level trauma center. One hundred and eight resident doctors participated in the study. All the participants were divided into two groups after randomization. Group A was given the original drug ampoule while the modified ampoule with contrast was given to Group B. Total time in reading the ampoule and difficulty in reading (DR) scoring were noted for each participant. Another scoring regarding correct reading of ampoule was also noted and compared.
METHODS: Student\'s t-test and Mann-Whitney test were used accordingly and P < 0.05 was considered as significant.
RESULTS: It was found that mean time taken in reading the original ampoule was more compared to modified ampoule (11.64 ± 1.48 vs. 9.48 ± 1.62 seconds P < 0.05). DR score was also higher in Group A (P < 0.05) and correct reading score was more in Group B (P < 0.05).
CONCLUSIONS: The labels on drug ampoules or vials should always have a contrasting background. This may reduce medication error and improve patient safety.

OBJECTIVE: Standard ampoules and prefilled syringes of adrenaline are widely available in Australasian EDs for use in cardiac arrest. We hypothesise that prefilled syringes can be administered more rapidly and accurately when compared with the two available standard ampoules.
METHODS: This is a triple arm superiority study comparing the time to i.v. administration and accuracy of dosing of three currently available preparations of adrenaline.
RESULTS: In their standard packaging, prefilled syringes were on average more than 12 s faster to administer than the 1 mL 1:1000 ampoules and more than 16 s faster than the 10 mL 1:10,000 ampoules (P < 0.01 in both comparisons). With packaging removed, the time to administration was equal for the 1 mL (1:1000) ampoule and the prefilled syringe. Accuracy of dosing was excellent with both the 10 mL (1:10 000) ampoules and prefilled syringes. The 1 mL (1:1000) ampoules delivered a small number of markedly inaccurate doses, but these did not reach statistical significance.
CONCLUSIONS: The speed of administration of adrenaline utilising a Minijet (CSL Limited, Parkville, Victoria, Australia) is faster than using adrenaline in glass ampoules presented in their plastic packaging. Removing the plastic packaging from the 1 mL (1 mg) ampoule might result in more rapid administration similar to the Minijet. Resuscitation personnel requiring rapid access to adrenaline should consider storing it as either Minijets or ampoules devoid of packaging. These results might be extrapolatable to other clinical scenarios, including pre-hospital and anaesthesia, where other drugs are required for rapid use.

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