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

Tran, Ann; O’Sullivan, David; Krawczynski, Michelle

doi:10.1177/0897190017734442

Cited by 13 publications

(21 citation statements)

References 15 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…78,79,106 Although not FDA-approved, cefepime and ceftriaxone may also be administered IV push. 2,3,78,79,85 Data for cefepime are limited to use as the first-dose in the ED, with limited outcome and adverse event data provided in reports. 2,3 One additional study evaluated cefepime administered IV push, but the required volume for preparation was 50 mL, losing volume minimization advantages of IV push.…”

Section: Cephalosporinsmentioning

confidence: 99%

“…2,3,78,79,85 Data for cefepime are limited to use as the first-dose in the ED, with limited outcome and adverse event data provided in reports. 2,3 One additional study evaluated cefepime administered IV push, but the required volume for preparation was 50 mL, losing volume minimization advantages of IV push. 85 Ceftriaxone IV push administration has been evaluated in several settings, including in the ED, with OPAT, and in hospitalized patients, with no noted concerns.…”

Section: Cephalosporinsmentioning

confidence: 99%

“…1 In addition, the faster administration time may provide advantages in the emergency department (ED), so that time-to-first-dose can be shortened. 2,3 There may also be interest in IV push administration in the setting of drug or fluid shortages, such as the current shortage of small volume parenteral (SVP) solutions (ie, 50 or 100 mL bags for intermittent IV infusion). 4 In response, the American Society of Health-Systems Pharmacists recommends switching medication administration to IV push when possible to help conserve SVP supplies in the context of a shortage.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Intravenous Push Administration of Antibiotics: Literature and Considerations

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

Section: Cephalosporinsmentioning

confidence: 99%

Section: Cephalosporinsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intravenous Push Administration of Antibiotics: Literature and Considerations

et al. 2018

View full text Add to dashboard Cite

show abstract

“… 59 For combination therapy of cefepime and vancomycin, worries about incompatibility between two antibiotics would result in conventional practice (ie, flush the tube with diluent and initiate vancomycin infusion when cefepime infusion over 30–60 minutes is completed). Tran et al 60 evaluated whether an intravenous push of cefepime (a mixture of 10 mL normal saline injected over 2–5 minutes) was associated with a shorter time to vancomycin administration in the emergency department compared with intravenous piggyback infusion (a mixture of 100 mL normal saline infused over 30–60 minutes). The transition from intravenous piggyback infusion to intravenous push of cefepime could statistically significantly decrease the time to initiation of vancomycin administration by more than 1 hour to patients with suspected infections who were ordered both antibiotics.…”

Section: Resultsmentioning

confidence: 99%

Optimal infusion rate in antimicrobial therapy: explosion of evidence in the last five years

Zhu¹,

Zhou²

2018

IDR

View full text Add to dashboard Cite

BackgroundSporadic studies in antimicrobial therapy have evaluated the effects of infusion rates on therapeutic and economic outcomes, and new findings may challenge the regular infusion regimen.MethodsFocusing on studies comparing the outcomes of different infusion regimens, the relevant literature was identified by searching PubMed, Web of Science, and Scopus from January 1, 2013 to March 1, 2018. Papers were finally chosen using a PRISMA flowchart.ResultsAntimicrobials with the superiority of prolonged infusion to standard infusion in terms of efficacy and safety include meropenem, doripenem, imipenem, cefepime, ceftazidime, piperacillin/tazobactam, linezolid, and vancomycin. The strategy of concomitantly reducing total daily dose and prolonging infusion time may cause treatment failure (eg, imipenem). Extended infusion of piperacillin/tazobactam has pharmacoeconomic advantage over standard infusion. Prolonged infusion of voriconazole is inferior to standard infusion because of lower efficacy caused by pharmacokinetic changes. Comparable outcomes following standard infusion and continuous infusion were observed with norvancomycin and nafcillin. Factors determining whether prolonged infusion has a benefit over standard infusion include MIC of bacterial pathogens, bacterial density, diagnosis, disease severity, total daily dose, and renal function.ConclusionTo maximally preserve the effectiveness of current antimicrobials, effective interventions should be implemented to enhance the application of optimal infusion strategies. For reducing nephrotoxicity, prolonged infusion of meropenem is better than conventional infusion in neonates with Gram-negative late-onset sepsis, and continuous infusion of vancomycin is superior to intermittent infusion. For increasing efficacy, prolonged or continuous infusion of time-dependent antimicrobials (eg, meropenem, doripenem, imipenem, cefepime, ceftazidime, piperacillin/tazobactam, linezolid, and vancomycin) is an optimal choice. Nevertheless, such advantages may only be demonstrated in special clinical circumstances and special populations (eg, patients with a sequential organ failure assessment (SOFA) score≥9, respiratory tract infections, urinary or intra-abdominal infections, or infections caused by less susceptible pathogens would benefit from prolonged infusion of piperacillin/tazobactam).

show abstract

“…Current pharmacokinetic literature examining the differences between administration of beta‐lactams as intravenous piggyback (IVPB) over 30 minutes (min) and as IVP over 5 min found no significant differences in target attainment between the two, however, these data were limited to small sample sizes of primarily healthy subjects that may not be generalizable to infected patients 1‐4 . Furthermore, clinical studies utilizing IVP administration of antibiotics are limited to surgical prophylaxis or first dose only in the emergency department 5‐7 . Given the scarcity of information evaluating beta‐lactam antimicrobials administered as IVP, our goal was to evaluate and compare clinical and microbiological outcomes between empiric FEP or MEM administered as IVPB compared to IVP in Gram‐negative bacteremia (GNB).…”

Section: What Is Known and Objectivementioning

confidence: 99%

Intravenous push versus intravenous piggyback beta‐lactams for the empiric management of gram‐negative bacteremia

et al. 2020

View full text Add to dashboard Cite

What is known and objective Nationwide shortages of small‐volume parenteral solutions (SVPS) compelled hospitals to develop strategies including the use of intravenous push (IVP) administration of antibiotics to reserve SVPS for absolute necessities. It is unknown if administration of beta‐lactam antibiotics (BL) via IVP results in worse clinical outcomes compared to intravenous piggyback (IVPB) due to the potential inability to achieve pharmacodynamic targets. Methods Our health‐system implemented a mandatory IVP action plan for BL from October 2017 to September 2018. This was a retrospective study of adult patients with GNB who received empiric therapy with IVPB (30 minutes) or IVP (5 minutes) cefepime (FEP) or meropenem (MEM) for at least 2 days. Endpoints included clinical response, microbiological clearance and mortality. All data are presented as n (%) or median (interquartile range). Results The final cohort included 213 patients (IVPB n = 105, IVP n = 108). The primary source of bacteremia was urinary, with Escherichia coli being the primary pathogen. Escalation of therapy was similar between groups (15 [14%] vs 11 [10%], P = .36) at a median of 3 days (P = .68). No significant differences were observed in any secondary endpoints including microbiological clearance, bacteremia recurrence, time to defervescence, WBC normalization, vasopressor duration or in‐hospital mortality. What is new and conclusion Our findings suggest no differences in clinical response with the use of IVP compared to IVPB FEP and MEM for treatment of GNB. This form of administration may be considered as a fluid conservation strategy in times of shortage.

show abstract

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

Abstract: The use of first-dose cefepime IVP in the ED resulted in a statistically significant decrease in time to vancomycin administration of over 1 hour.

Cited by 13 publications

References 15 publications

Intravenous Push Administration of Antibiotics: Literature and Considerations

Intravenous Push Administration of Antibiotics: Literature and Considerations

Optimal infusion rate in antimicrobial therapy: explosion of evidence in the last five years

Intravenous push versus intravenous piggyback beta‐lactams for the empiric management of gram‐negative bacteremia

Contact Info

Product

Resources

About