Hosp Pharm. 2018 Jun; 53(3): 157–169. 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 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 fluid-restricted, 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. 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 FDA-approved 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. Summary of Available IV Push or Slow Injection
Data.a,7-29
Table 1 provides a summary of antibiotics that can be administered IV push. Stability data are limited to solutions (eg, concentrations, diluents) that can be used for IV push administration. Because there is no exact definition of IV push and a wide range of administration durations were considered IV push in the original sources, Table 1 separates administration recommendations into 2 categories. Administration over 5 minutes or less are listed as IV push, while administration over longer durations of time (eg, over 5-10 minutes) are listed as slow IV injection; however, specific administration times are provided. Figure 1 lists antibiotics that had no data or limited data suggesting IV push as a viable administration method; therefore, these antibiotics are excluded from Table 1. Antibiotics with limited or no data for IV push administration. See the text summaries for each drug class for further information. aLimited data available, not recommended for IV push administration. AminoglycosidesNone of the aminoglycosides are indicated for IV push administration.7-9,46 Aminoglycosides are generally not recommended for IV push administration due to the concern that elevated peak levels after rapid administration may cause toxicity, such as ototoxicity.9,65,88 Specifically, the PI for tobramycin notes that peak serum levels may exceed 12 μg/mL when administered over periods <20 minutes.9 However, IV push administration of gentamicin and tobramycin has been reported frequently in primary literature.89-100 Table 1 includes a summary of studies with sufficient detail to replicate administration, including a descriptive report demonstrating that gentamicin and tobramycin can be safely administered IV push based on experience with 5593 doses in the setting of outpatient parenteral antibiotic therapy (OPAT).67 In addition to the studies cited in Table 1, gentamicin has reportedly been administered over time periods ranging from <10 seconds to 5 minutes,89-91,93-96 while tobramycin has been administered over time periods ranging from 15 seconds to 5 minutes.89,90,96-101 Most administration times for gentamicin and tobramycin ranged from approximately 3 to 5 minutes. These studies were of varying quality and instructions for preparation were not described. There are limited reports of IV push administration with amikacin; one healthy volunteer study (n = 5) evaluated administration of 7.5 mg/kg directly from the manufacturer vial (250 mg/mL) over 2 minutes, but this resulted in potentially toxic peak serum concentrations (68-122 μg/mL).102 Amikacin has been administered over 3 minutes and 5 minutes, respectively, in 2 additional pharmacokinetic studies; however, dilution and preparation instructions were not reported.103,104 Reports of streptomycin administered via IV push were not identified. CarbapenemsOf the carbapenems, only meropenem is FDA- approved to be administered IV push.11 Doripenem and meropenem/vaborbactam should only be given via intermittent IV infusion; no data are available to support IV push administration.35,37 One pharmacokinetic study was identified describing administration of imipenem/cilastatin 500 mg over 10 minutes in 6 patients undergoing continuous ambulatory peritoneal dialysis; the volume/concentration of the administered solution was not provided.105 However, IV push administration of imipenem/cilastatin is not recommended due to adverse events associated with rapid administration, such as nausea and vomiting.61,66 Administration of ertapenem 1 gram IV push over 5 minutes was bioequivalent to the 30-minute infusion for maximum serum concentration (Cmax) and area under the curve (AUC) in a study in 12 healthy volunteers, and no serious adverse events, such as vomiting or seizures, occurred (Table 1).76 CephalosporinsCefazolin, cefotaxime, cefotetan, cefoxitin, ceftazidime, and cefuroxime are FDA-approved for IV push administration.12,14-18,20 Studies comparing IV push and short-term infusion administration of cephalosporins have generally found similar rates of phlebitis and other complications.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.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.2,78,79 Additional data on ceftriaxone IV push administration exist, but the majority of studies did not robustly report both preparation and administration details or focused solely on pediatric populations.107-109 Only 3 cephalosporins lack information for IV push administration: ceftazidime/avibactam, ceftolozane/tazobactam, and ceftaroline. Specific adverse events related to IV push administration of cefotaxime and ceftriaxone are noted in the literature. A potentially life-threatening arrhythmia occurred in 6 patients who received rapid (<1 minute) administration of cefotaxime through a central venous catheter.14 Rapid ceftriaxone administration (2 grams over 5 minutes) was associated with a case of palpitation, tachycardia, restlessness, shivering, and diaphoresis in an adult.110 Ceftriaxone has also been reported to be associated with increased biliary pseudolithiasis in children given ceftriaxone over 3 to 5 minutes, and with the formation of calcium-ceftriaxone precipitate in neonates receiving concurrent calcium-containing solutions who received ceftriaxone over 2 to 4 minutes, which led to adverse cardiopulmonary events.111,112 Glycopeptides/Lipoglycopeptides/LipopeptidesDaptomycin (both Cubicin and Cubicin RF) may be administered IV push in adults when reconstituted to a concentration of 50 mg/mL.21,22 While this practice has been reported to be safe in adults,113-115 a case report exists documenting an IV push-related reaction to daptomycin (Cubicin) administered over 2 minutes involving redness and a warm sensation on the face, neck, and upper chest that resolved with diphenhydramine and did not recur with rechallenge of a 30- to 40-minute infusion.116 The newer agents of these classes are not amenable to IV push administration; dalbavancin, oritavancin, and telavancin are administered via extended infusions ranging from 1 to 3 hours, and no recent literature reports their administration over shorter periods.38-40 Vancomycin, because of the risk for infusion reaction (ie, “red-man syndrome”), should be administered no more rapidly than 10 mg/minute or over a period of ≥60 minutes, whichever is longer.60,61,65,66 Infusion reactions can be mediated by both the concentration and rate of administration of vancomycin. For patients in need of fluid restriction, vancomycin may be administered at concentrations up to 10 mg/mL, though this may increase the risk for infusion reaction. FluoroquinolonesFluoroquinolones (ciprofloxacin, levofloxacin, and moxifloxacin) are not recommended for IV push administration due to adverse events associated with rapid administration.57-59,61,66 These adverse events include venous irritation with ciprofloxacin, hypotension with levofloxacin, and an increase in the incidence and magnitude of QT prolongation with moxifloxacin. In addition, moxifloxacin is only available in premix formulations intended for intermittent IV infusion.6,58 In order to reduce venous irritation, slow IV infusion of ciprofloxacin into a large vein is recommended.59 Although reports of ciprofloxacin administration over a period ranging from 3 to 15 minutes were identified, these studies did not specifically aim to evaluate the safety and efficacy of the IV push administration.117-119 In 2 pharmacokinetic studies in healthy volunteers, ciprofloxacin was administered via rapid injection over 3 or 5 minutes, but the volume and concentration of the administered solutions were not specified.117,118 In one of these studies, observed adverse events with administration of ciprofloxacin 250 mg over 5 minutes in 8 healthy volunteers included localized numbness (n = 1), local thrombophlebitis (n = 1), and nausea (n = 1).117 In another study in 12 healthy volunteers, ciprofloxacin 50 mg and 100 mg was prepared in 50 mL normal saline and administered over 15 minutes with a constant pump, with no observed adverse events.119 However, these doses are lower than those commonly used in clinical practice.60 Penicillins and MonobactamAmong the penicillins, ampicillin may be administered IV push or as a slow IV injection after reconstitution, depending on the dose.26 Administration faster than recommended by the PI may increase the risk of seizures.26,60,65 In addition, ampicillin has limited stability, which decreases with increasing concentrations.63 Nafcillin and oxacillin require administration via slow IV injection (eg, over 5-10 minutes).28,29 Phlebitis may occur if these agents are injected too rapidly.60 Of note, profound hypotension has been reported among patients receiving IV push administration of nafcillin during coronary artery bypass graft surgery, presumed to be due to histamine-mediated vasodilation.120 Penicillin G and piperacillin/tazobactam are not recommended for IV push administration. Ampicillin/sulbactam is recommended to be diluted in volumes that may preclude practical administration via slow IV injection (eg, 1.5 g vials in 50 mL to obtain maximum 30 mg/mL concentration).27 Although a study in 16 patients undergoing colorectal surgery reported IV push administration of 2 g/1 g ampicillin/sulbactam over 3 minutes, the concentration of the solution was not reported.121 Similarly to ampicillin, seizures may occur with rapid administration of ampicillin/sulbactam.66 Finally, the monobactam aztreonam is indicated for IV push administration after reconstitution of vials.23 PolymyxinsColistimethate sodium can be administered IV push.25 After reconstitution, the manufacturer recommends use within 7 days. However, colistimethate sodium can hydrolyze to colistin in aqueous solution. Although this conversion was minimally observed in one stability study (<1% after storage of reconstituted solution at 4° or 25°C for 7 d in the dark), the authors cautioned that reconstitution should still be done as close to administration as possible, and if it is necessary to store the solution, they recommend storage at 4°C to minimize bacterial contamination.122 With regard to the safety of IV push administration, 1 patient out of 12 in a trial assessing the safety and tolerability of IV push colistimethate reported dizziness/lack of coordination after receiving 160 mg in 10 mL over 5 minutes.123 This resolved when the patient was switched to an intermittent IV infusion over 30 minutes. Polymyxin B is FDA-approved to be given as an IV infusion, intramuscularly, or intrathecally.45 Administration of polymyxin B over a period <30 minutes is not recommended, and rapid IV injections should be avoided due to the potential for nephro- or neurotoxicity.62,124 TetracyclinesDoxycycline, minocycline, and tigecycline are recommended to be administered as an intermittent IV infusion and are not suitable for IV push administration.42-44 The PIs for doxycycline and minocycline specifically state that rapid administration is not recommended, and oral administration is preferred over parenteral administration.42,43 Phlebitis and burning have been observed with more concentrated solutions of doxycycline.65,125 OthersOf the antibiotics that are not included in the classes already discussed, only chloramphenicol can be administered IV push.24 All of the other agents have specific statements against IV push administration in at least one tertiary resource.60-63,65,66 Of note, Seifert and colleagues documented a report of severe nausea, cramping, and hypotension after administration of erythromycin 1 g in 100 mL of normal saline over 10 minutes.126 In addition, Aucoin and colleagues reported a case of complete heart block following administration of clindamycin 600 mg over several minutes; the same patient tolerated subsequent clindamycin infusions over 30 minutes without incident.127 Rapid lincomycin administration has also been associated with severe cardiac events including cardiopulmonary arrest.128 Linezolid and metronidazole are not available in a vial formulation so these drugs are not practical to administer IV push.6,51,52 One observational pharmacokinetic study documented rapid IV push of metronidazole 500 mg over 5 minutes, but the volume/concentration of the administered solution was not specified so these data are not readily applicable to current clinical practice.129 Practical Considerations for IV Push AntibioticsSeveral organizations have issued guidance or recommendations for safe IV administration practices.130 The Institute for Safe Medication Practices (ISMP) provides guidance on adult IV push medication safety.131 Briefly, this guidance supports preparation of IV push medications in the pharmacy so that a ready-to-administer form can be provided to patient care areas. In cases where immediate administration is required for medication stability, preparation and dilution of the medication can occur in patient care areas. In those instances, dilution should take place in a clean, uncluttered area with clear instructions on the type and volume of diluent that is needed. Syringes should be promptly labeled; supplying blank, ready-to-apply labels may help with adherence to that step. Considerations for safe administration of IV push medications can be found in the ISMP guidance document. The 2016 Infusion Nurses Society (INS) Infusion Therapy Standards of Practice largely mirror the ISMP recommendations for safe preparation of medications for IV push administration.132 Osmolality is a concern when administering concentrated solutions. The 2016 INS Infusion Therapy Standards of Practice state that solutions with osmolality >900 mOsm/kg should be administered through a central line and solutions with osmolalities below this limit can be administered via peripheral or midline catheters.132 The Standards of Practice do not have any statements that connect osmolality and administration rate; therefore, there does not seem to be any added concern with IV push administration of solutions with higher osmolalities compared with slower administration rates. Osmolality data is not readily available in product labeling or other tertiary resources and most published osmolality values are based on historical literature that is not readily applicable to current practice.1,78,133-135 With the limitation that not all agents have relevant data, our review of all available published and unpublished (manufacturer-supplied) osmolality information for the antibiotics that can be administered IV push suggests that the recommended solutions for IV push administration all have osmolalities well below 900 mOsm/kg. Additional steps that help ensure safe use of IV push medications include providing a specific administration duration on the label or in the electronic medication administration record (eg, “administer over 10 minutes” rather than “slow IV injection”).131 Nurse education on proper dilution of IV push medications may also facilitate proper preparation. A 2014 ISMP survey found that 83% of nurse respondents further dilute certain IV push medications prior to administration.136 Unnecessary dilution of medications can lead to contamination of sterile products, dosing errors, or administration errors. Multidose vials should not be kept in patient care areas per the Centers for Disease Control and Prevention One & Only Campaign, which prevents both inadvertent use in multiple patients and errors related to IV push administration of these solutions.137 Pharmacodynamic Considerations for IV Push AntibioticsThe pharmacodynamic effect of antibiotics can be generalized into either concentration-dependent or time-dependent bactericidal activity.138 For agents that are concentration-dependent, maximizing the AUC per unit of time in relation to the bacterial minimum inhibitory concentration (MIC) generally increases the rapidity of bacterial killing and thus increases the likelihood of a good clinical outcome. For example, daptomycin has concentration-dependent bactericidal activity and a change in the rate of infusion (eg, a 30-minute infusion versus a 5-minute injection) does not significantly affect the resulting AUC. For beta-lactams, increasing the infusion duration can substantially increase the duration of time that the drug concentration remains above the MIC (T > MIC); therefore, changing from an infusion to IV push administration may negatively affect the pharmacodynamics of these agents. One Monte Carlo simulation study and one healthy volunteer pharmacokinetic study have investigated the impact of IV push administration.76,139 Based on these results, 3- to 5-minute IV push injections and 30-minute infusions of aztreonam, cefepime, ertapenem, and meropenem are expected to achieve similar T > MIC profiles. In contrast, the difference in T > MIC between a 3- to 5-minute IV push injection (or 30-minute infusion) and an extended (eg, over 3 or 4 hours) or continuous infusion can be clinically significant.140 Several studies have found that extended and continuous infusion strategies are associated with improved clinical cure and survival, particularly in severely ill patients, compared with shorter infusion durations.141-143 Therefore, current data do not support the substitution of IV push administration for extended or continuous infusion schemes in patients who are critically ill, immunocompromised, or infected with organisms with MICs at or above the clinical breakpoint for susceptibility (eg, Pseudomonas with a piperacillin/tazobactam MIC of 16 μg/mL). ConclusionSeveral antibiotics, particularly in the cephalosporin class, are FDA-approved for IV push or slow IV injection administration. In addition, there are primary literature data that support IV push administration of cefepime, ceftriaxone, ertapenem, gentamicin, and tobramycin. Syringe stability data are not available for all antibiotics, which may preclude IV push administration if preparation in patient care areas for immediate use is not possible. Precautions should be taken to ensure safe IV push administration, including clear labeling and staff education. Pharmacodynamic changes due to IV push administration should be considered, including effects on time above MIC when administering antibiotics via IV push that are normally administered as extended or continuous infusions. AcknowledgmentsThe authors gratefully acknowledge Jack Rasmussen, PharmD candidate, for his support in data collection. FootnotesDeclaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article. ORCID iDs: Samantha Spencer https://orcid.org/0000-0002-8496-3554Heather Ipema https://orcid.org/0000-0002-0981-1358References1. Robinson DC, Cookson TL, Grisafe JA. Concentration guidelines for parenteral antibiotics in fluid-restricted patients. Drug Intell Clin Pharm. 1987;21(12):985–989. [PubMed] [Google Scholar] 2. McLaughlin JM, Scott RA, Koenig SL, Mueller SW. Intravenous push cephalosporin antibiotics in the emergency department: a practice improvement project. Adv Emerg Nurs J. 2017;39(4):295–299. [PubMed] [Google Scholar] 3. Tran A, O’Sullivan D, Krawczynski M. Cefepime intravenous push versus intravenous piggyback on time to administration of first-dose vancomycin in the emergency department. J Pharm Pract. 2017:897190017734442. [PubMed] [Google Scholar] 5. Gilbert DN, Chambers HF, Eliopoulos GM, Saag MS. The Sanford Guide to Antimicrobial Therapy 2017. 47th ed. Sperryville, VA: Antimicrobial Therapy, Inc; 2017. [Google Scholar] 6. Food and Drug Administration website. Orange book: approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/. Accessed December 16, 2017. 7. Amikacin sulfate: full prescribing information. Eatontown, NJ: West-ward; 2016. [Google Scholar] 8. Gentamicin sulfate: full prescribing information. Lake Forest, IL: Hospira Inc; 2017. [Google Scholar] 9. Tobramycin: full prescribing information. North Brunswick, NJ: Claris Lifesciences Inc; 2016. [Google Scholar] 10. Invanz (ertapenem): full prescribing information. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; 2017. [Google Scholar] 11. Merrem (meropenem): full prescribing information. Wilming-ton, DE: Astrazeneca Pharmaceuticals Lp; 2016. [Google Scholar] 12. Cefazolin: full prescribing information. Weston, FL: Apotex Corp; 2017. [Google Scholar] 13. Maxipime (cefepime): full prescribing information. Lake Forest, IL: Hospira Inc; 2017. [Google Scholar] 14. Claforan (cefotaxime): full prescribing information. Bridgewater, NJ: Sanofi-Aventis US LLC; 2016. [Google Scholar] 15. Cefotan (cefotetan): full prescribing information. Buena, NJ: Teligent Pharma Inc; 2017. [Google Scholar] 16. Cefoxitin: full prescribing information. Weston, FL: Apotex Corp; 2017. [Google Scholar] 17. Tazicef (ceftazidime): full prescribing information. Lake Forest, IL: Hospira Inc; 2016. [Google Scholar] 18. Fortaz (ceftazidime): full prescribing information. Buena, NJ: Teligent Pharma Inc; 2017. [Google Scholar] 19. Ceftriaxone: full prescribing information. Weston, FL: Apotex Corp; 2017. [Google Scholar] 20. Cefuroxime sodium: full prescribing information. Schaumburg, IL: Sagent Pharmaceuticals; 2016. [Google Scholar] 21. Cubicin (daptomycin): full prescribing information. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; 2017. [Google Scholar] 22. Cubicin RF (daptomycin): full prescribing information. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; 2017. [Google Scholar] 23. Azactam (aztreonam): full prescribing information. Princeton, NJ: Bristol-Myers Squibb; 2013. [Google Scholar] 24. Chloramphenicol sodium succinate: full prescribing information. Schaumburg, IL: Fresenius Kabi USA LLC; 2016. [Google Scholar] 25. Coly-Mycin M (colistimethate): full prescribing information. Chestnut Ridge, NY: Par Pharmaceutical; 2017. [Google Scholar] 26. Ampicillin sodium: full prescribing information. Lake Zurich, IL: Fresenius Kabi USA LLC; 2017. [Google Scholar] 27. Unasyn (ampicillin and sulbactam): full prescribing information. New York, NY: Pfizer Inc; 2017. [Google Scholar] 28. Nafcillin: full prescribing information. Austria: Sandoz GmbH; 2017. [Google Scholar] 29. Oxacillin: full prescribing information. Newtown, PA: Renaissance SSA LLC; 2017. [Google Scholar] 30. Penicillin G potassium: full prescribing information. Princeton, NJ: Sandoz Inc; 2015. [Google Scholar] 31. Zosyn (piperacillin and tazobactam): full prescribing information. Philadelphia, PA: Wyeth Pharmaceuticals Inc; 2017. [Google Scholar] 32. Teflaro (ceftaroline): full prescribing information. New York, NY: Forest Pharmaceuticals Inc; 2016. [Google Scholar] 33. Zerbaxa (ceftolozane and tazobactam): full prescribing information. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; 2016. [Google Scholar] 34. Avycaz (ceftazidime and avibactam): full prescribing information. Irvine, CA: Allergan USA; 2017. [Google Scholar] 35. Doripenem: full prescribing information. Weston, FL: Apotex Corp; 2016. [Google Scholar] 36. Primaxin (imipenem and cilastatin): full prescribing information. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; 2016. [Google Scholar] 37. Vabomere (meropenem and vaborbactam): full prescribing information. Parsippany, NJ: The Medicines Company; 2017. [Google Scholar] 38. Dalvance (dalbavancin): full prescribing information. Parsippany, NJ: Durata Therapeutics US Limited; 2016. [Google Scholar] 39. Orbactive (oritavancin): full prescribing information. Parsippany, NJ: The Medicines Company; 2016. [Google Scholar] 40. Vibativ (telavancin): full prescribing information. South San Francisco, CA: Theravance Biopharma US Inc; 2016. [Google Scholar] 41. Vancomycin: full prescribing information. Lake Zurich, IL: Fresenius Kabi USA LLC; 2017. [Google Scholar] 42. Doxy 100 (doxycycline): full prescribing information. Lake Zurich, IL: Fresenius Kabi USA LLC; 2015. [Google Scholar] 43. Minocin (minocycline): full prescribing information. Parsippany, NJ: The Medicines Company; 2015. [Google Scholar] 44. Tygacil (tigecycline): full prescribing information. Philadelphia, PA: Wyeth Pharmaceuticals Inc; 201. [Google Scholar] 45. Polymyxin B: full prescribing information. Pine Brook, NJ: Alvogen Inc; 2017. [Google Scholar] 46. Streptomycin: full prescribing information. Big Flats, NY: X-Gen Pharmaceuticals Inc; 2013. [Google Scholar] 47. Zithromax (azithromycin): full prescribing information. New York, NY: Pfizer Inc; 2017. [Google Scholar] 48. Cleocin (clindamycin): full prescribing information. New York, NY: Pharmacia and Upjohn Company LLC; 2016. [Google Scholar] 49. Erythrocin lactobionate (erythromycin): full prescribing information. Lake Forest, IL: Hospira Inc; 2016. [Google Scholar] 50. Lincocin (lincomycin): full prescribing information. New York, NY: Pharmacia and Upjohn Company LLC; 2017. [Google Scholar] 51. Zyvox (linezolid): full prescribing information. New York, NY: Pharmacia and Upjohn Company LLC; 2017. [Google Scholar] 52. Metronidazole: full prescribing information. Lake Forest, IL: Hospira Inc; 2017. [Google Scholar] 53. Synercid (quinupristin and dalfopristin): full prescribing information. New York, NY: Pfizer Laboratories Inc; 2017. [Google Scholar] 54. Rifadin (rifampin): full prescribing information. Bridgewater, NJ: Sanofi-Aventis US LLC; 2017. [Google Scholar] 55. Sivextro (tedizolid): full prescribing information. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; 2017. [Google Scholar] 56. Sulfamethoxazole and trimethoprim: full prescribing information. Rockford, IL: Mylan Institutional LLC; 2017. [Google Scholar] 57. Levofloxacin: full prescribing information. East Windsor, NJ: AuroMedics Pharma LLC; 2017. [Google Scholar] 58. Moxifloxacin: full prescribing information. Rockford, IL: Mylan Institutional LLC; 2017. [Google Scholar] 59. Ciprofloxacin: full prescribing information. North Brunswick, NJ: Claris Lifesciences Inc; 2016. [Google Scholar] 62. McEvoy GK, ed. AHFS Drug Information. 2016th ed. Bethesda, MD: American Society of Health-System Pharmacists, Inc; 2016. https://www.medicinescomplete.com/mc/. Accessed December 18, 2017. [Google Scholar] 63. McEvoy G. Handbook on Injectable Drugs. 19th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2017. [Google Scholar] 64. Bing CD, Nowobilski-Vasilios A. Extended Stability for Parenteral Drugs. 6th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2017. [Google Scholar] 65. Phelps SJ, Hagemann TM, Lee KR, Thompson AJ. Pediatric Injectable Drugs. 10th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013. [Google Scholar] 66. Gahart BL, Nazareno AR, Ortega MQ. Gahart’s 2017 Intravenous Medications: A Handbook for Nurses and Health Professionals. 33rd ed. St. Louis, MO: Elsevier, Inc; 2017. [Google Scholar] 67. Loewenthal MR, Dobson PM. Tobramycin and gentamicin can safely be given by slow push. J Antimicrob Chemother. 2010;65(9):2049–2050. [PubMed] [Google Scholar] 68. Mendelson J, Portnoy J, Dick V, Black M. Safety of the bolus administration of gentamicin. Antimicrob Agents Chemother. 1976;9(4):633–638. [PMC free article] [PubMed] [Google Scholar] 69. Meunier F, Van der Auwera P, Schmitt H, de Maertelaer V, Klastersky J. Pharmacokinetics of gentamicin after i.v. infusion or iv bolus. J Antimicrob Chemother. 1987;19(2):225–231. [PubMed] [Google Scholar] 70. Scott DK, Edwards C. Optimization of blood sampling time after intravenous bolus doses of gentamicin. J Clin Pharm Ther. 1989;14(1):61–70. [PubMed] [Google Scholar] 71. Kresel JJ, Smith AL, Siber GR. Stability of gentamicin in plastic syringes. Am J Hosp Pharm. 1977;34(6):570–575. [PubMed] [Google Scholar] 72. Weiner B, McNeely DJ, Kluge RM, Stewart RB. Stability of gentamicin sulfate injection following unit dose repackaging. Am J Hosp Pharm. 1976;33(12):1254–1259. [PubMed] [Google Scholar] 73. Chrai SS, Ambrosio TJ. Gentamicin sulfate injection repackaging in syringes. Am J Hosp Pharm. 1977;34(9):920. [PubMed] [Google Scholar] 74. Aoyama H, Izawa Y, Nishizaki A, Okuda J. Optimal conditions for injection of tobramycin and cefmenoxime into burn patients. Burns Incl Therm Inj. 1987;13(4):269–276. [PubMed] [Google Scholar] 75. Seitz DJ, Archambault JR, Kresel JJ, Brinck-Johnsen T. Stability of tobramycin sulfate in plastic syringes. Am J Hosp Pharm. 1980;37(12):1614–1615. [PubMed] [Google Scholar] 76. Wiskirchen DE, Housman ST, Quintiliani R, Nicolau DP, Kuti JL. Comparative pharmacokinetics, pharmacodynamics, and tolerability of ertapenem 1 gram/day administered as a rapid 5-minute infusion versus the standard 30-minute infusion in healthy adult volunteers. Pharmacotherapy. 2013;33(3):266–274. [PubMed] [Google Scholar] 77. Jain JG, Sutherland C, Nicolau DP, Kuti JL. Stability of ertapenem 100 mg/mL in polypropylene syringes stored at 25, 4, and -20 degrees C. Am J Health Syst Pharm. 2014;71(17):1480–1484. [PubMed] [Google Scholar] 78. Garrelts JC, Ast D, LaRocca J, Smith DF, Jr, Peterie JD. Postinfusion phlebitis after intravenous push versus intravenous piggyback administration of antimicrobial agents. Clin Pharm. 1988;7(10):760–765. [PubMed] [Google Scholar] 79. Poole SM, Nowobilski-Vasilios A, Free F. Intravenous push medications in the home. J Intraven Nurs. 1999;22(4):209–215. [PubMed] [Google Scholar] 80. Bornstein M, Thomas PN, Coleman DL, Boylan JC. Stability of parenteral solutions of cefazolin sodium. Am J Hosp Pharm. 1974;31(3):296–298. [PubMed] [Google Scholar] 81. Borst DL, Sesin GP, Cersosimo RJ. Stability of selected beta-lactam antibiotics stored in plastic syringes. NITA. 1987;10(5):368–372. [PubMed] [Google Scholar] 82. Donnelly RF. Stability of cefazolin sodium in polypropylene syringes and polyvinylchloride minibags. Can J Hosp Pharm. 2011;64(4):241–245. [PMC free article] [PubMed] [Google Scholar] 83. Stewart JT, Warren FW, Maddox FC. Stability of cefepime hydrochloride injection in polypropylene syringes at -20 degrees C, 4 degrees C, and 22-24 degrees C. Am J Health Syst Pharm. 1999;56(5):457–459. [PubMed] [Google Scholar] 84. Stewart JT, Maddox FC, Warren FW. Stability of cefepime hydrochloride in polypropylene syringes. Am J Health Syst Pharm. 1999;56(11):1134. [PubMed] [Google Scholar] 85. Garrelts JC, Wagner DJ. The pharmacokinetics, safety, and tolerance of cefepime administered as an intravenous bolus or as a rapid infusion. Ann Pharmacother. 1999;33(12):1258–1261. [PubMed] [Google Scholar] 86. Stewart JT, Warren FW, Johnson SM, Fox JL, Mullaney J. Stability of ceftazidime in plastic syringes and glass vials under various storage conditions. Am J Hosp Pharm. 1992;49(11):2765–2768. [PubMed] [Google Scholar] 87. Plumridge RJ, Rieck AM, Annus TP, Langton SR. Stability of ceftriaxone sodium in polypropylene syringes at -20, 4, and 20 degrees C. Am J Health Syst Pharm. 1996;53(19):2320–2323. [PubMed] [Google Scholar] 88. Robinson RF, Nahata MC. Safety of intravenous bolus administration of gentamicin in pediatric patients. Ann Pharmacother. 2001;35(11):1327–1331. [PubMed] [Google Scholar] 89. Dobbs SM, Mawer GE. Intravenous injection of gentamicin and tobramycin without impairment of hearing. J Infect Dis. 1976;134 Suppl:S114–S117. [PubMed] [Google Scholar] 90. Stratford BC, Dixson S, Cobcroft AJ. Serum levels of gentamicin and tobramycin after slow intravenous bolus injection. Lancet. 1974;1(7854):378–379. [PubMed] [Google Scholar] 91. Van de Walle J, Adriaensen H. Letter: serum-gentamicin levels after intravenous bolus injection. Lancet. 1974;2(7879):525–526. [PubMed] [Google Scholar] 92. Lynn KL, Neale TJ, Little PJ, Bailey RR. Gentamicin by intravenous bolus injection. N Z Med J. 1974;80(528):442–443. [PubMed] [Google Scholar] 93. Edwards C, Bint AJ, Venables CW, Scott DK. Sampling time for serum gentamicin levels. J Antimicrob Chemother. 1992;29(5):575–578. [PubMed] [Google Scholar] 94. Korsager S. Administration o gentamicin to obese patients. Int J Clin Pharmacol Ther Toxicol. 1980;18(12):549–553. [PubMed] [Google Scholar] 95. Daschner FD, Eschenbruch E, Metz B, Bayer E, Schmuziger M. Penetration of gentamicin into heart valves, subcutaneous and muscular tissue of patients undergoing open heart surgery. J Cardiovasc Surg (Torino). 1981;22(6):581–584. [PubMed] [Google Scholar] 96. Bastone EB, Li SC, Ioannides-Demos LL, Spicer WJ, McLean AJ. Kill kinetics and regrowth patterns of Escherichia coli exposed to gentamicin concentration-time profiles simulating in vivo bolus and infusion dosing. Antimicrob Agents Chemother. 1993;37(4):914–917. [PMC free article] [PubMed] [Google Scholar] 97. Gillett AP, Falk RH, Andrews J, Wise R, Melikian V. Rapid intravenous injection of tobramycin: suggested dosage schedule and concentrations in serum. J Infect Dis. 1976;134 Suppl:S110–S113. [PubMed] [Google Scholar] 98. Lilliestierna H, Alestig K, Holm S. Tobramycin therapy–two or three doses per day? Scand J Infect Dis. 1985;17(3):323–325. [PubMed] [Google Scholar] 99. Adeboyeku D, Jones AL, Hodson ME. Twice vs three-times daily antibiotics in the treatment of pulmonary exacerbations of cystic fibrosis. J Cyst Fibros. 2011;10(1):25–30. [PubMed] [Google Scholar] 100. Blouin RA, Mann HJ, Griffen WO, Jr, Bauer LA, Record KE. Tobramycin pharmacokinetics in morbidly obese patients. Clin Pharmacol Ther. 1979;26(4):508–512. [PubMed] [Google Scholar] 101. Nafziger AN, Schwartzman MS, Bertino JS., Jr Absence of tobramycin pharmacokinetic and creatinine clearance variation during the menstrual cycle: implied absence of variation in glomerular filtration rate. J Clin Pharmacol. 1989;29(8):757–763. [PubMed] [Google Scholar] 102. Pechere JC, Dugal R, Pechere MM. Pharmacokinetics of intravenous amikacin after rapid and slow infusion with special reference to hemodialysis. Eur J Drug Metab Pharmacokinet. 1979;4(1):49–56. [PubMed] [Google Scholar] 103. Limthongkul S, Charoenlap P, Nuchprayoon CJ, Udompanich V, Songkhla YN. Amikacin pharmacokinetics in plasma and pleural fluid. J Med Assoc Thai. 1989;72(2):90–96. [PubMed] [Google Scholar] 104. Yates RA, Mitchard M. Disposition studies with amikacin after rapid intravenous and intramuscular administration to human volunteers. J Antimicrob Chemother. 1978;4(4):335–341. [PubMed] [Google Scholar] 105. Somani P, Freimer EH, Gross ML, Higgins JT., Jr. Pharmacokinetics of imipenem-cilastatin in patients with renal insufficiency undergoing continuous ambulatory peritoneal dialysis. Antimicrob Agents Chemother. 1988;32(4):530–534. [PMC free article] [PubMed] [Google Scholar] 106. Biggar C, Nichols C. Comparison of postinfusion phlebitis in intravenous push versus intravenous piggyback cefazolin. J Infus Nurs. 2012;35(6):384–388. [PubMed] [Google Scholar] 107. Baumgartner JD, Glauser MP. Single daily dose treatment of severe refractory infections with ceftriaxone. Cost savings and possible parenteral outpatient treatment. Arch Intern Med. 1983;143(10):1868–1873. [PubMed] [Google Scholar] 108. Grubbauer HM, Dornbusch HJ, Dittrich P, et al. Ceftriaxone monotherapy for bacterial meningitis in children. Chemotherapy. 1990;36(6):441–447. [PubMed] [Google Scholar] 109. Schaad UB, Stoeckel K. Single-dose pharmacokinetics of ceftriaxone in infants and young children. Antimicrob Agents Chemother. 1982;21(2):248–253. [PMC free article] [PubMed] [Google Scholar] 110. Lossos IS, Lossos A. Hazards of rapid administration of ceftriaxone. Ann Pharmacother. 1994;28(6):807–808. [PubMed] [Google Scholar] 111. Schaad UB, Wedgwood-Krucko J, Tschaeppeler H. Reversible ceftriaxone-associated biliary pseudolithiasis in children. Lancet. 1988;2(8625):1411–1413. [PubMed] [Google Scholar] 112. Bradley JS, Wassel RT, Lee L, Nambiar S. Intravenous ceftriaxone and calcium in the neonate: assessing the risk for cardiopulmonary adverse events. Pediatrics. 2009;123(4):e609–e613. [PubMed] [Google Scholar] 113. Cervera C, Sanroma P, Gonzalez-Ramallo V, et al. Safety and efficacy of daptomycin in outpatient parenteral antimicrobial therapy: a prospective and multicenter cohort study (DAPTODOM trial). Infect Dis (Lond). 2017;49(3):200–207. [PubMed] [Google Scholar] 114. Schmidt S, Sloan A, Maxwell A, Swindler J. Evaluation of a standardized daptomycin dosing nomogram. Am J Health Syst Pharm. 2016;73(17)(suppl 4):S106–S111. [PubMed] [Google Scholar] 115. Aoki I, Ishikawa K, Wakana A, Aso M, Yoshinari T. Evaluation of the safety, tolerability, and pharmacokinetics of a single bolus injection of daptomycin in healthy Japanese subjects. J Infect Chemother. 2015;21(3):170–175. [PubMed] [Google Scholar] 116. Caulder CR, Sloan A, Yasir A, Bookstaver PB. Infusion-related reaction following daptomycin two-minute rapid intravenous administration. Hosp Pharm. 2014;49(7):644–646. [PMC free article] [PubMed] [Google Scholar] 117. Ljungberg B, Nilsson-Ehle I. Pharmacokinetics of intravenous ciprofloxacin at three different doses. J Antimicrob Chemother. 1988;22(5):715–720. [PubMed] [Google Scholar] 118. Adler D, Maier H. Gyrase inhibitor ciprofloxacin in human parotid saliva. J Clin Chem Clin Biochem. 1989;27(4):232–233. [PubMed] [Google Scholar] 119. Hoffken G, Lode H, Prinzing C, et al. Pharmacokinetics of ciprofloxacin after oral and parenteral administration. Antimicrob Agents Chemother. 1985;27(3):375–379. [PMC free article] [PubMed] [Google Scholar] 120. Casthely PA, Ergin MA, Yoganathan T, et al. Hemodynamic changes after nafcillin administration during coronary artery bypass surgery. J Cardiothorac Anesth. 1989;3(2):168–171. [PubMed] [Google Scholar] 121. Martin C, Cotin A, Giraud A, et al. Comparison of concentrations of sulbactam-ampicillin administered by bolus injections or bolus plus continuous infusion in tissues of patients undergoing colorectal surgery. Antimicrob Agents Chemother. 1998;42(5):1093–1097. [PMC free article] [PubMed] [Google Scholar] 122. Wallace SJ, Li J, Rayner CR, Coulthard K, Nation RL. Stability of colistin methanesulfonate in pharmaceutical products and solutions for administration to patients. Antimicrob Agents Chemother. 2008;52(9):3047–3051. [PMC free article] [PubMed] [Google Scholar] 123. Conway SP, Etherington C, Munday J, Goldman MH, Strong JJ, Wootton M. Safety and tolerability of bolus intravenous colistin in acute respiratory exacerbations in adults with cystic fibrosis. Ann Pharmacother. 2000;34(11):1238–1242. [PubMed] [Google Scholar] 124. Grayson ML. Kucers’ the Use of Antibiotics: A Clinical Review of Antibacterial, Antifungal, Antiparasitic and Antiviral Drugs. Vol 1, 6th ed. London, England: Edward Arnold; 2010. [Google Scholar] 125. Holloway WJ. Preliminary report on intravenous doxycycline. Del Med J. 1971;43(11):394–397. [PubMed] [Google Scholar] 126. Seifert CF, Swaney RJ, Bellanger-McCleery RA. Intravenous erythromycin lactobionate-induced severe nausea and vomiting. DICP. 1989;23(1):40–44. [PubMed] [Google Scholar] 127. Aucoin P, Beckner RR, Gantz NM. Clindamycin-induced cardiac arrest. South Med J. 1982;75(6):768. [PubMed] [Google Scholar] 128. Waisbren BA. Lincomycin in larger doses. JAMA. 1968;206(9):2118. [PubMed] [Google Scholar] 129. Ljungberg B, Nilsson-Ehle I, Ursing B. Metronidazole: pharmacokinetic observations in severely ill patients. J Antimicrob Chemother. 1984;14(3):275–283. [PubMed] [Google Scholar] 130. Lenz JR, Degnan DD, Hertig JB, Stevenson JG. A review of best practices for intravenous push medication administration. J Infus Nurs. 2017;40(6):354–358. [PubMed] [Google Scholar] 132. Adams J, Bierman S, Mares A, et al. Infusion therapy standards of practice. J Infus Nurs. 2016;39(1S):S1–S156. [Google Scholar] 133. Nowobilski-Vasilios A, Poole SM. Development and preliminary outcomes of a program for administering antimicrobials by i.v. push in home care. Am J Health Syst Pharm. 1999;56(1):76–79. [PubMed] [Google Scholar] 134. Santeiro ML, Sagraves R, Allen LV., Jr Osmolality of small-volume i.v. admixtures for pediatric patients. Am J Hosp Pharm. 1990;47(6):1359–1364. [PubMed] [Google Scholar] 135. Miano B, Wood W. Implementation of the i.v. push method of antibiotic administration using the FOCUS/PDCA approach. Home Healthc Nurse. 1998;16(12):831–837. [PubMed] [Google Scholar] 137. Centers for Disease Control Prevention. One and only campaign. Centers for Disease Control and Prevention website; http://www.oneandonlycampaign.org/. Accessed December 18, 2017. [Google Scholar] 138. Craig WA. Pharmacokinetic/pharmacodynamic parameters: rationale for antibacterial dosing of mice and men. Clin Infect Dis. 1998;26(1):1–10. [PubMed] [Google Scholar] 139. Butterfield-Cowper JM, Burgner K. Effects of i.v. push administration on β-lactam pharmacodynamics. Am J Health Syst Pharm. 2017;74(9):e170–e175. [PubMed] [Google Scholar] 140. Jaruratanasirikul S, Sriwiriyajan S, Punyo J. Comparison of the pharmacodynamics of meropenem in patients with ventilator-associated pneumonia following administration by 3-hour infusion or bolus injection. Antimicrob Agents Chemother. 2005;49(4):1337–1339. [PMC free article] [PubMed] [Google Scholar] 141. Lodise TP, Jr, Lomaestro B, Drusano GL. Piperacillin-tazobactam for Pseudomonas aeruginosa infection: clinical implications of an extended-infusion dosing strategy. Clin Infect Dis. 2007;44(3):357–363. [PubMed] [Google Scholar] 142. Rhodes NJ, Liu J, O’Donnell JN, et al. Prolonged infusion piperacillin-tazobactam decreases mortality and improves outcomes in severely ill patients: results of a systematic review and meta-analysis. Crit Care Med. 2018;46:236–243. [PubMed] [Google Scholar] 143. Dulhunty JM, Roberts JA, Davis JS, et al. Continuous infusion of beta-lactam antibiotics in severe sepsis: a multicenter double-blind, randomized controlled trial. Clin Infect Dis. 2013;56(2):236–244. 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