Improving Initial Management of Septic Patients: Comparing Intravenous Push vs. Intravenous Piggyback Antibiotics

Although β-lactam antibiotics are traditionally administered through intravenous piggyback (IVPB), intravenous push (IVP) antibiotics have become more popular recently, given they have a shortened time to administration, which may impact patient outcomes.

This study explores the advantages of using IVP vs. IVPB method by evaluating the difference in time from sepsis diagnosis to first dose administration of broad-spectrum antibiotics.

This single-center retrospective cohort study utilized emergency department (ED) charts from 200 patients admitted with sepsis to our instiution's ED between 2014 and 2021 who received either IVP or IVPB methods for antibiotic administration.

The median time to antibiotic administration was 27 min for IVP (27 [15.5-39]) vs. 33.5 min for IVPB (33.5 [17-72.5]) (p = 0.049). Similarly, the median time to completion of all antibiotic administration was 110.5 min for IVP (110.5 [64-222.5]) vs. 168.6 min IVPB (168.5 [101.5-302]) (p = 0.0004) and the median time (hours) to completion of the "hour-one" sepsis bundle was 1.71 for IVP (1.71 [0.84-3]) vs. 2.02 for IVPB (2.02 [1.11-4.78]) (p = 0.0234). Additionally, whereas IVP administration decreased time to antibiotic administration, no significant increases in reported side effects were noted.

The IVP route of administration for β-lactam antibiotics compared with IVPB for antibiotics requires less time needed for the sepsis bundle completion and for antibiotic administration, leading to better efficiency for the ED workflow.