Push Dose Intravenous Antibiotics

Aka: Push Dose Intravenous Antibiotics, Antibiotic Bolus Dosing

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II. Definitions

  1. Push Dose Intravenous Antibiotics
    1. Antibiotics that may be bolused intravenously (without infusion)

III. Advantages

  1. Rapid delivery of medication
  2. No need for additional preparation into a bag
  3. Does not monopolize the intravenous line

IV. Precautions

  1. Do not dilute formulations beyond their prepared concentration prior to bolus dosing
  2. Avoid bolusing high osmolality agents (>900 mOsm/kg)
  3. Do not replace continuous infusions in critically ill, Immunocompromised or patients with infections with borderline MIC

V. Preparations: Intravenous Bolus (FDA approved for bolus unless otherwise noted)

  1. Penicillins
    1. Ampicillin or Ampicillin/Sulbactam (Unasyn)
    2. Oxacillin or Nafcillin
    3. Piperacillin/Tazobactam (Zosyn, not FDA approved for bolus)
  2. Cephalosporins
    1. Cefazolin
    2. Cefotaxime
    3. Cefotetan
    4. Cefoxitin
    5. Cefuroxime
    6. Ceftazidime
    7. Cefepime (not FDA approved for bolus)
    8. Ceftriaxone (not FDA approved for bolus)
  3. Carbapenems
    1. Meropenem
    2. Ertapenem (not FDA approved for bolus)
  4. Monobactams
    1. Aztreonam
  5. Aminoglycosides (not FDA approved for bolus)
    1. Gentamicin
    2. Tobramycin

VI. Preparations: Intramuscular

  1. Ceftriaxone
  2. Penicillin G Benzathine Penicillin
  3. Streptomycin

VII. References

  1. Hayes and Swaminathan in Herbert (2021) EM:Rap 21(4): 8-9

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