antibioticlock

Antibiotic lock therapy (ALT), or antibiotic lock, is a technique used with indwelling vascular catheters in which a high-concentration antibiotic solution is instilled into the catheter lumen and left in place (dwell) for a defined period. The aim is to eradicate intraluminal biofilm and to treat or prevent catheter-related bloodstream infections (CRBSIs) while preserving the catheter.

In practice, ALT involves filling each catheter lumen with a concentrated antibiotic solution and allowing it to dwell for several hours up to about 24 hours before flushing and resuming catheter use. It is typically employed as an adjunct to systemic antibiotic therapy and is considered when catheter salvage is desirable or when removal would be particularly burdensome. Commonly used agents include antibiotics such as vancomycin or aminoglycosides, sometimes combined with rifampin, and the choice depends on the suspected or proven pathogen, local resistance patterns, and catheter material.

Indications for ALT revolve around CRBSI management and prevention in patients with long-term central venous access, particularly where catheter retention is prioritized. It has been studied for hemodialysis and other long-term catheters. While several trials and reviews support ALT as a means to improve catheter salvage in select infections, evidence is heterogeneous across organisms and clinical contexts, and ALT is not universally recommended for all CRBSIs. Guidelines emphasize that ALT should complement systemic antimicrobial therapy and appropriate catheter management, including removal in cases of certain pathogens or treatment failures.

Safety considerations include the risk of systemic toxicity if the lock solution enters systemic circulation, potential development of antimicrobial resistance, and compatibility issues with catheter materials. Alternatives such as ethanol-lock therapy or taurolidine-citrate locks are also used in some settings. Overall, ALT is one component of a broader strategy for managing catheter-related infections and is guided by organism, patient factors, and institutional protocols.