In this episode, I’ll discuss an article about IV push piperacillin-tazobactam.
Article
Safety and tolerability of i.v. push piperacillin/tazobactam within an emergency department
Lead author: William Blake Hays
Published in American Journal of Health-System Pharmacy May 2020
Background
Piperacillin/tazobactam is typically administered via IV piggyback over 30 minutes or more increasingly common via extended infusion over 4 hours.
In order to meet first dose antibiotic timeliness goals, many practitioners prefer IV push antibiotics. However, data for IV push administration of piperacillin/tazobactam is lacking and there is concern that the high osmolality of the reconstituted solution could cause IV push-related side effects. The authors of this study sought to retrospectively assess the safety and tolerability of piperacillin/tazobactam administered peripherally by IVP.
Methods
The study was designed as a single-center retrospective chart review of patients who received administration of a single dose of IVP piperacillin/tazobactam through a peripheral line in an emergency department.
Results
Over 1800 patients who received 1 dose of IVP piperacillin/tazobactam were identified and 300 of these patients were randomly selected for assessment of safety and tolerability. All but one patient tolerated IVP piperacillin/tazobactam for a tolerability rate of 99.7%. The one patient with a side effect had an allergic reaction which included itching and hives. There were no infusion-related reactions including phlebitis or IV site reactions that were documented.
Conclusion
The authors concluded:
IVP administration of piperacillin/tazobactam through a peripheral site is safe and tolerable for adult patients.
Discussion
Although ongoing administration of piperacillin/tazobactam is likely best done as an extended infusion to provide adequate time above MIC, IV push administration of the first dose could allow for a more timely administration and in circumstances with limited IV access and the need for additional antibiotics such as vancomycin could allow for a faster time to completion of administration of broad-spectrum antibiotics.
While the benefits of this strategy have not been demonstrated, it is apparent that safety in terms of adverse effects from the IV push route appears to be a non-issue. What remains unclear is, if the first dose of piperacillin/tazobactam was given IV push and subsequent doses are given IV over 4 hours every 8 hours, when is the ideal timing of the 2nd dose? Likely waiting 8 hours to start the 2nd dose is too long.
If your institution adopts this practice consider coming to a consensus of when to schedule the 2nd dose to avoid an unnecessarily long period where the antibiotic concentration is below the MIC.
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