What is the proper administration of intravenous (IV) antibiotics for infection?

From the Guidelines

Intravenous (IV) antibiotics for infection should be administered as soon as possible after recognition and within one hour for both sepsis and septic shock, with the goal of achieving effective antimicrobial therapy within the first hour of recognition 1. The process involves selecting an appropriate antibiotic based on the suspected or confirmed infection, establishing IV access using a peripheral or central venous catheter, and administering the medication according to specific protocols.

• Common IV antibiotics include ceftriaxone (1-2g daily), vancomycin (15-20mg/kg every 8-12 hours), piperacillin-tazobactam (4.5g every 6-8 hours), and meropenem (1g every 8 hours) 1.
• The antibiotic choice depends on the infection site, severity, suspected organism, and patient factors like allergies and kidney function.
• Administration requires proper aseptic technique, correct dilution in compatible IV fluids, and appropriate infusion rates to prevent complications.
• Treatment duration typically ranges from 7-14 days depending on the infection type and patient response, with some conditions requiring longer therapy, as recommended by guidelines for the treatment of pneumonia 1.
• IV antibiotics work by achieving high blood concentrations quickly, making them ideal for severe infections.
• Regular monitoring of vital signs, infusion site, and laboratory values is essential to assess treatment effectiveness and detect adverse reactions.
• Transitioning to oral antibiotics is considered when the patient shows clinical improvement and can tolerate oral medications.
• The Surviving Sepsis Campaign recommends administering effective IV antimicrobials within the first hour of recognition of septic shock and severe sepsis without septic shock, and reassessing the antimicrobial regimen daily for potential de-escalation 1.

From the FDA Drug Label

The desired dose diluted in this manner should be administered by intermittent IV infusion over a period of at least 60 minutes. Administer the diluted piperacillin and tazobactam for injection solution by infusion over a period of at least 30 minutes (a programmable syringe or infusion pump is recommended). To give IV antibiotics for infection, the recommended method of administration is by intermittent infusion.

• For vancomycin, the infusion should be administered over a period of at least 60 minutes 2.
• For piperacillin-tazobactam, the infusion should be administered over a period of at least 30 minutes 3. Key considerations include:
• Using a compatible infusion solution
• Diluting the solution to the recommended concentration
• Administering the solution through an IV line
• Flushing the IV line between administrations of different antibiotics.

From the Research

Administration of IV Antibiotics

• IV antibiotics can be administered as an intravenous bolus or infusion, with some antibiotics being more suitable for one method over the other 4
• The timing of antibiotic administration is crucial in the treatment of life-threatening infections, with delays in administration leading to increased mortality 5
• The selection of appropriate antibiotics is also important, with the goal of selecting agents that are active against the offending pathogens based on in vitro susceptibility 5

Specific Antibiotics

• Meropenem is a broad-spectrum antibacterial agent that is effective against a range of serious bacterial infections, including complicated intra-abdominal infection, complicated skin and skin structure infection, and bacterial meningitis 6
• Meropenem has been shown to be effective in the treatment of febrile neutropenia, nosocomial pneumonia, and severe community-acquired pneumonia, and is suitable for administration as an intravenous bolus or infusion 6
• Other antibiotics, such as cefepime, ceftriaxone, ertapenem, gentamicin, and tobramycin, have also been shown to be effective in the treatment of various infections and can be administered via IV push 4

Considerations for Administration

• The duration of antibiotic infusions can influence antibiotic efficacy, with longer infusions potentially increasing antimicrobial drug exposure for the offending pathogen 5
• However, aggressive antimicrobial de-escalation based on microbiology results is necessary to counterbalance the pressures of early broad-spectrum antibiotic therapy 5
• Practical considerations, such as IV push best practices and pharmacodynamic considerations, should also be taken into account when administering IV antibiotics 4