Intravenous Push Administration of Antibiotics: Literature and Considerations

Abstract

Intravenous (IV) push administration can provide clinical and practical advantages over longer IV infusions in multiple clinical scenarios, including in the emergency department, in fluid-restricted patients, and when supplies of diluents are limited. In these settings, conversion to IV push administration may provide a solution. This review compiles available data on IV push administration of antibiotics in adults, including preparation, stability, and administration instructions. Prescribing information, multiple tertiary drug resources, and primary literature were consulted to compile relevant data. Several antibiotics are Food and Drug Administration-approved for IV push administration, including many beta-lactams. In addition, cefepime, ceftriaxone, ertapenem, gentamicin, and tobramycin have primary literature data to support IV push administration. While amikacin, ciprofloxacin, imipenem/cilastatin, and metronidazole have limited primary literature data on IV push administration, available data do not support that route. In addition, a discussion on practical considerations, such as IV push best practices and pharmacodynamic considerations, is provided.

Surgical Antibiotic Prophylaxis in an Era of Antibiotic Resistance: Common Resistant Bacteria and Wider Considerations for Practice

“… 19 Typically, commencement of vancomycin and fluoroquinolone infusions commences 1-hour prior to surgical incision, as shortened infusions can cause adverse effects, including “red-man syndrome” with vancomycin and venous irritation with fluoroquinolones. 147 While standard infusion times may vary at an institutional level, vancomycin is typically administered at a rate of 1g/hour. Similarly, ciprofloxacin is infused over 60 minutes and levofloxacin over 60 or 90 minutes for doses of ≤500mg and >500mg, respectively.…”

Safety and efficacy of a 5-minute infusion versus the standard 30-minute infusion for antibiotics in an outpatient setting

“…Additionally, rapid infusions are administered using minimal fluid volume. This benefits patients who are fluid-restricted and saves costs on diluents (Spencer et al, 2018).…”

Pharmacy Interventions to Minimize Use of Personnel Protective Equipment and Limiting Caregiver Exposure During Coronavirus Disease 2019

“…Potential pharmacokinetic and pharmacodynamic disadvantages of administering beta lactam antibiotics as IV push and the substantial advantages with giving them as extended infusions should be considered prior to implementing this strategy. 8 Table 1 has listed details of antibiotics which can be given as IV push with recommended reconstitution and administration time. 9,10…”