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

Abstract

Study Objective:

The combination of cefepime and vancomycin is commonly used as an empiric antimicrobial regimen. Time to first-dose antibiotics is associated with survival benefit. The objective of this study is to evaluate whether cefepime intravenous push (IVP) is associated with a shorter time to vancomycin administration in the emergency department (ED) compared with cefepime intravenous piggyback (IVPB) infusion.

Methods:

This was a retrospective chart review of records of patients who were treated with the vancomycin–cefepime combination in the ED.

Results:

A total of 1071 charts from April 2013 to January 2015 were reviewed. Included in the pre-(IVBP) group was 536 subjects and 535 subjects in the post-(IVP) group. The indications for antibiotic therapy were sepsis alone (28.3%), pneumonia alone (30.7%), sepsis with pneumonia (36.5%), and other (4.6%). The median time from administration of cefepime to vancomycin were 63.5 minutes and 2.0 minutes in the IVPB and IVP cohorts, respectively (P < .001).

Conclusion:

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.

Keywords

cefepime emergency medicine empiric antibiotics medication administration methods

Get full access to this article

View all access options for this article.

References

Rhodes

Evans

Alhazzani

. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304–377.

Ferrer

Martin-Loeches

Phillips

. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med. 2014;42(8):1749–1755.

Kumar

Roberts

Wood

. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589–1596.

Martin

Mannino

Eaton

. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546–1554.

Mayr

Yende

Angus

. Epidemiology of severe sepsis. Virulence. 2014;5(1):4–11.

Ambrose

Bui

Richerson

. Pharmacoeconomic analysis of intravenous push vs slow infusion of β-lactam antibiotics. Clin Drug Invest. 1999;17(5).407–410.

Biggar

Nichols

. Comparison of postinfusion phlebitis in intravenous push versus intravenous piggyback cefazolin. J Infus Nurs. 2012;35(6):384–388.

Ambrose

Quintiliani

Nightingale

. Pharmacoeconomic analysis of administration of famotidine iv push vs. intermittent slow iv infusion (letter). Ann Pharmacother. 1997;31(5):645.

Nowobilski-Vasilios

Poole

. 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.

10.

Pharmaceutical compounding-sterile preparations (general information chapter 797). In: The United States pharmacopeia and National Formulary. 22nd ed. Rockville, MD: The United States Pharmacopeial Convention; 2004:2350–2370.

11.

Brown

Crapo

. The key to transitioning from fee-for-service to value-based reimbursement. Health Catalyst. 2014.

12.

Garrelts

Wagner

. The pharmacokinetics, safety, and tolerance of cefepime administered as an intravenous bolus or as a rapid infusion. Ann Pharmacother. 1999;33(12):1258–1261.

13.

Markowsky

Santeiro

. Automatic therapeutic substitution: cost savings with intravenous push famotidine. Ann Pharmacother. 1995;29(3):316.

14.

Barie

Hydo

Shou

. Influence of antibiotic therapy on mortality of critical surgical illness caused or complicated by infection. Surg Infect (Larchmt). 2005;6(1):41–54.

15.

Garrelts

Smith

Ast

. A comparison of the safety, timing and cost-effectiveness of administering antibiotics by intravenous bolus (push) versus intravenous piggyback (slow infusion) in surgical prophylaxis. Pharmacoeconomics. 1992;1(2):116–123.

16.

Jaruratanasirikul

Sriwiriyajan

Ingviya

. Continuous infusion versus intermittent administration of cefepime in patients with Gram-negative bacilli bacteraemia. J Pharm Pharmacol. 2002;54(12):1693–1696.

17.

Craig

. Interrelationship between pharmacokinetics and pharmacodynamics in determining dosage regimens for broad-spectrum cephalosporins. Diagn Microbiol Infect Dis. 1995;22(1-2):89–96.

18.

Garrelts

Ast

LaRocca

. Postinfusion phlebitis after intravenous push versus intravenous piggyback administration of antimicrobial agents. Clin Pharm. 1988;7(10):760–765.