Reconsidering the Push: Intravenous Push Ceftriaxone in the Emergency Department

Empiric antibiotic administration is a routine and essential component of emergency department (ED) care. Traditionally, intravenous piggyback (IVPB) administration has been used to deliver antibiotics such as ceftriaxone, allowing for dilution and controlled infusion to minimize adverse effects. With nationwide IV fluid shortages putting a squeeze on supplies, clinicians have started thinking outside the bag - literally. Enter intravenous push (IVP) administration, a faster way to get antibiotics into patients that saves time, fluids, and supplies. Following the transition from IVPB to IVP ceftriaxone at some institutions, there have been reports of adverse reactions, including rare but serious events such as hemodynamic instability and possible cardiac arrest, prompting concerns regarding the safety of IVP antibiotic administration. But what is actually causing these adverse reactions? And is the benefit of switching to IVP ceftriaxone worth the potential risk? This presentation will review emerging safety data and the role of IVP ceftriaxone in the ED.