Intravenous push shortens time to initiation of antibiotics in ED

Administration of ampicillin/sulbactam, piperacillin/tazobactam, and ertapenem via intravenous push (IVP) results in better times to initiation of empiric, first-dose antibiotics in the emergency department, (ED) without increasing the incidence of adverse events (AEs), a study has shown.

In addition to these improvements, IVP administration of the three antibiotics has led to an estimated annual savings of more than $5,000.

“We found no difference in reported or chart-documented AEs when comparing IVP ampicillin/sulbactam, piperacillin/tazobactam, and ertapenem to IV piggy-back (IVPB) [administration],” the researchers said. “An IVP protocol was associated with an increased proportion of patients meeting 60- and 180-minute Surviving Sepsis Campaign (SSC) antibiotic administration goals.”

In this single-centre pre-post protocol study, the researchers evaluated changes in administration timing and safety of ampicillin/sulbactam, piperacillin/tazobactam, and ertapenem from 2015–2018. They assessed medication administration by IVPB (pre) or IVP (post), ED arrival, antibiotic order, and administration times, potential effectors of administration time, and safety events. In addition, they estimated acquisition costs.

A total of 696 administrations were assessed, of which 351 were in the IVPB cohort and 345 in the IVP. The median time from ED arrival to initiation of antibiotic administration was 140 min in the IVBP cohort and 110 min in the IVP cohort (p<0.01). [J Pharm Pract 2022;35:369-376]

Furthermore, IVP administration resulted in an increase in the proportion of indexed antibiotics dispensed within 60 min of ED arrival compared to IVPB (20 percent vs 12 percent; p<0.01). AEs were comparable between the two cohorts. However, the IVP protocol led to supply acquisition cost saving of more than $5,000.

“The results of this study confirm, with a large data set, that IVP administration is associated with improved time to antibiotic administration in the ED,” the researchers said. “We confirmed this practice was independently associated with prompt antibiotic administration in patients admitted with sepsis, severe infection, or admission to the intensive care unit.”

Early administration

Timing of antibiotics administration is essential in improving the condition of acutely ill patients, particularly those with septic phenomena. Patients with low severity signs of infections are at risk of disease progression, according to the researchers. In septic shock patients, death risk increased by 7.6 percent for every additional hour with no antibiotics. [Crit Care Med 2006;34:1589-1596]

A study by Gaieski and colleagues highlighted the importance of the length of time from triage to administration of appropriate antibiotics in the relationship between death and the time of administration in severe sepsis and septic shock. [Crit Care Med 2010;38:1045-1053]

Because of this, the SSC recommends administration of broad-spectrum antibiotics to septic patients within 60 or 180 min of arrival. [Crit Care Med 2014;24:1749-1755; Crit Care Med 2018;46:997-1000; Crit Care Resusc 2006;8:181-182]

“Early appropriate antibiotic administration is associated with improved outcomes in infectious illnesses,” the researchers said. “During drug shortages in 2017, the American Society of Health-System Pharmacists recommended IVP administration of medications when possible to conserve small-volume parenteral solutions.”