Hospital Pharmacy - June 2018 - 157

760257
research-article2018

HPXXXX10.1177/0018578718760257Hospital PharmacySpencer et al.

Article

Intravenous Push Administration of
Antibiotics: Literature and Considerations

Hospital Pharmacy
2018, Vol. 53(3) 157-169
© The Author(s) 2018
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https://doi.org/10.1177/0018578718760257
DOI: 10.1177/0018578718760257
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Samantha Spencer1 , Heather Ipema1 , Patricia Hartke1,
Courtney Krueger1, Ryan Rodriguez1, Alan E. Gross1,
and Michael Gabay1

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.
Keywords
anti-infectives, drug stability, intravenous therapy

Introduction
Antibiotics are commonly administered intravenous (IV)
medications. Many of these drugs can be administered via IV
push, intermittent IV infusion, and/or continuous IV infusion,
depending on the medication. IV push allows for administration of an antibiotic in a minimal fluid volume. Small fluid
volumes can be particularly useful in patients who are fluidrestricted, such as patients with acute volume overload or
acute renal failure.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. Therefore, the purpose of this article is to summarize the available data that support IV push administration of antibiotics in adults.

Methods
A list of commercially available injectable antibiotics was
generated from The Sanford Guide and the Food and Drug

Administration (FDA) Orange Book.5,6 The prescribing information (PI) was used as the primary resource for FDAapproved routes of administration and stability data.7-59 The
PIs for vials for reconstitution were selected if available
because vial formulations are most readily prepared for IV
push administration. Additional tertiary drug resources were
used to confirm the information found in the PI and provide
additional data, if available.60-66 Primary literature citations
from tertiary sources were reviewed in their full-text form. A
primary literature search was also performed of the MEDLINE
and International Pharmaceutical Abstracts (IPA) databases.
Each drug name was paired with the following terms to capture published data on IV push administration: intravenous,
inject*, parenteral*, "administration and dosage"[MeSH
Subheading], push, bolus, rapid, fast. All sources were consulted for each drug to ascertain consensus recommendations;
in cases when information could only be located in one
source, a note is included in the comment column of Table 1
or in the text summaries for the antibiotics.
1

College of Pharmacy, University of Illinois at Chicago, USA

Corresponding Author:
Samantha Spencer, Clinical Assistant Professor, College of Pharmacy,
University of Illinois at Chicago, 833 S Wood St, 164 PHARM (MC 886),
Chicago, IL 60612, USA.
Email: sspencer@uic.edu
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