178 Safety Comparison of Antibiotics Administered via Intravenous Push versus Intravenous Piggyback to Adult Patients in the Emergency Department

Abstract

Prior to the 1980s, medications were commonly administered as intravenous (IV) push. However, the invention of intravenous piggybacks (IVPB) led to a shift in administration preference from IV push to IVPB. However, IV push administration could offer advantages in speed of administration and reduce costs. Although some data does exist about the safety of IV push antibiotics, as mentioned earlier, this data is generally retrospective in nature or has weak experimental design. Published prospective data is conducted in healthy volunteers and contains small sample sizes. No study on safety has been conducted in the emergency department setting. This study aims to examine the safety of IV push antibiotics in a randomized and controlled environment, examining rates and natures of adverse drug reactions in IV push antibiotics vs IVPB. This was a single center, prospective, double-blinded, double-dummy, randomized controlled trial on a convenience sample of patients presenting to the ED from April 2018 to October 2019 receiving select beta-lactam antibiotics. There was no significant difference in the number of specific adverse reactions or the total number of adverse reactions between the two arms at 90 minutes following the administration of antibiotics: 11.8% of patients in the Piggyback group had an adverse drug reaction (ADR), whereas 18.9% of patients in the Push group had an ADR (95% CI -9.5 to 23.8). Only 3 patients who had a grade 2 reaction, and they all received push antibiotics. Two developed abdominal pain and one developed headache. There were no patients with higher than a grade 2 adverse drug reaction in either arm. No statistically significant difference in safety profile was found between IV push antibiotics versus IVPB administration of antibioticsView Large Image Figure ViewerDownload Hi-res image Download (PPT)