Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
University of Colorado Hospital, Aurora, CO, USA.
J Pharm Pract. 2022 Jun;35(3):369-376. doi: 10.1177/0897190020977758. Epub 2020 Dec 11.
Early appropriate antibiotic administration is associated with improved outcomes in infectious illnesses. During drug shortages in 2017, the American Society of Health-System Pharmacists recommended intravenous push (IVP) administration of medications when possible to conserve small-volume parenteral solutions. Data supporting IVP penicillins and carbapenems was limited.
The primary objective of this study compared time from patient emergency department (ED) arrival to antibiotic administration between IVP and intravenous piggy-back (IVPB) administration.
This single-center pre-post protocol study assessed changes in administration timing and safety of ampicillin/sulbactam, piperacillin/tazobactam, and ertapenem from 2015-2018. Medication administration by IVPB (pre) or IVP (post), ED arrival, antibiotic order and administration times, potential effectors of administration time, and safety events were assessed. Acquisition costs were estimated.
A total of 696 administrations were included, with 351 and 345 subjects in the IVPB and IVP cohorts, respectively. The median time from ED arrival to initiation of antibiotic administration was 140 (IQR 87-221) minutes and 110 (IQR 68-181) minutes in the IVPB and IVP cohorts, respectively, (P < 0.01). IVP administration increased the proportion of indexed antibiotics administered within 60 minutes of ED arrival compared to IVPB (20% vs. 12%, respectively, P < 0.01). There was no difference in adverse events between both cohorts. Supply acquisition cost savings totaled an more than $5,000 with the IVP protocol.
IVP administration of ampicillin/sulbactam, piperacillin/tazobactam, and ertapenem improved times to initiation of empiric, first-dose antibiotics in the ED without an increase in adverse events, saving over $5,000 annually.
早期使用适当的抗生素与改善传染病的预后相关。在 2017 年药物短缺期间，美国卫生系统药剂师学会建议在可能的情况下通过静脉推注（IVP）给药，以节省小容量的肠外溶液。支持 IVP 青霉素类和碳青霉烯类药物的数据有限。
本研究的主要目的是比较静脉推注（IVP）和静脉滴注（IVPB）给药时患者从急诊科（ED）到达至开始使用抗生素的时间。
这是一项单中心前后对照研究，评估了 2015-2018 年期间氨苄西林/舒巴坦、哌拉西林/他唑巴坦和厄他培南给药时间的变化和安全性。评估了通过 IVPB（前）或 IVP（后）给药、ED 到达、抗生素医嘱和给药时间、给药时间的潜在影响因素以及安全性事件。还估算了采购成本。
共纳入 696 次给药，IVPB 组和 IVP 组分别有 351 例和 345 例患者。IVPB 组和 IVP 组从 ED 到达至开始使用抗生素的中位时间分别为 140（IQR 87-221）分钟和 110（IQR 68-181）分钟（P < 0.01）。与 IVPB 组相比，IVP 给药使 ED 到达后 60 分钟内使用索引抗生素的比例增加（分别为 20%和 12%，P < 0.01）。两组间不良事件无差异。采用 IVP 方案可节省超过 5000 美元的采购成本。
IVP 给药氨苄西林/舒巴坦、哌拉西林/他唑巴坦和厄他培南可改善 ED 中经验性、首剂抗生素的起始时间，而不增加不良事件，每年可节省超过 5000 美元。
