A Comparison of the Safety, Timing and Cost-Effectiveness of Administering Antibiotics by Intravenous Bolus (Push) Versus Intravenous Piggyback (Slow Infusion) in Surgical Prophylaxis

Abstract

This study was carried out to evaluate the safety, timing and cost-effectiveness of administering perioperative antimicrobial prophylaxis with cefmetazole via intravenous (IV) bolus, or 'push', compared with the more common method of IV 'piggyback' administration. A total of 60 patients were studied, 30 in each group. No major adverse reactions were noted in either group. Phlebitis did not occur with either method of administration. Loss of patency was noted in 2 patients in the IV bolus group at the time of catheter removal. While no overall difference in timing of antibiotic administration in relation to the surgical procedure was noted, 2 patients in the IV piggyback group did not receive their preoperative dose until after surgery had started. Both pharmacy preparation time and nursing administration time were shorter with the IV push method, resulting in a cost avoidance of $US0.60 per dose. Material cost avoidance, primarily due to elimination of the minibag and IV tubing with bolus administration, was $US3.25 per dose. Extrapolated cost avoidance for our institution, for both prophylaxis and treatment, is $US184 000 per year. Administration of selected antibiotics by IV push is safe, allows optimal timing of administration, minimises preparation and administration time, and is cost-effective. Hospitals and outpatient care facilities should consider this alternative method of antibiotic administration.

Evaluation of the safety, tolerability, and pharmacokinetics of a single bolus injection of daptomycin in healthy Japanese subjects

“…One benefit is the reduced fluid volume needed to administer daptomycin. Other benefits of the bolus treatment are reported by Garrelts et al, such as optimal timing of administration and minimizing preparation and administration times [16]. That study compared the safety, timing, and cost-effectiveness of administering antibiotics by IV bolus versus IV infusion piggyback (slow infusion) in surgical prophylaxis [16].…”

Cefepime Intravenous Push Versus Intravenous Piggyback on Time to Administration of First-Dose Vancomycin in the Emergency Department

“…1 –3,14 When compared to IVPB antibiotic administration, Garrelts et al found that both pharmacy preparation time and nursing administration time were shorter in the IVP group. 15 By avoiding material costs, namely the minibag and intravenous tubing for IVPB, the researchers were able to demonstrate a cost avoidance of US$3.25 per dose. The extrapolated annual cost saving of the IVP method, for both treatment and prophylaxis, was US$184 000 in this study.…”

“…The extrapolated annual cost saving of the IVP method, for both treatment and prophylaxis, was US$184 000 in this study. 15…”

“…Some antibiotics, such as vancomycin, imipenem/cilastatin, and ciprofloxacin, are better given as slow IVPB due to the risk of infusion rate–related adverse reactions. 15 However, IVP administration of cephalosporins and extended-spectrum penicillins over 1 to 5 minutes have been shown to be safe, with no difference in the incidence of postinfusion phlebitis. 8,10,15,18…”

The Pharmacokinetics, Safety, and Tolerance of Cefepime Administered as an Intravenous Bolus or as a Rapid Infusion

“…1,2 This technique of administering intravenous antibiotics has been determined to be safe, practical, reliable, and cost effective. [3][4][5][6][7] Significant cost savings have also been documented for other drug categories when intravenous bolus was used instead of intravenous infusion. 8, 9 The intravenous bolus method avoids the cost of minibags, infusion pumps, and administration tubing.…”