. 2018 Mar 8;53(3):157–169. doi: 10.1177/0018578718760257

Table 1.

Summary of Available IV Push or Slow Injection Data.^a,7-29

Antibiotic	FDA-approved administration	IV push/IV slow injection			Notes
Antibiotic	FDA-approved administration	Preparation	Stability^b	Administration	Notes
Aminoglycosides
Gentamicin	Intermittent IV infusion IM Not approved for IV push administration	Off-label preparation Loewenthal 2010⁶⁷: Dilute doses <800 mg to 20 mL with NS; larger doses administered as 40 mg/mL solution supplied in manufacturer’s vials Mendelson 1976⁶⁸: Dilute dose in 50-mL D5W or NS (most patients received 120-mg doses) Meunier 1987⁶⁹: 80 mg prediluted in 2-mL NS (40 mg/mL) Scott 1989⁷⁰: Dilute doses to 20 mL with NS (doses were 6 mg/kg/d in divided doses or 2 mg/kg/dose)	Polypropylene syringe, 40 mg/mL^63,71: 30 d at 4°C or 25°C Plastic syringe, 40 mg/mL^63,72: average loss of 16% after 30 d and brown precipitate formed at both 4°C and 25°C Glass syringe, 40 mg/mL^63,72: average loss of 7% after 30 d, brown precipitate formed at 60 d at both 4°C and 25°C Possible instability with storage in plastic packaging due to potential oxygen exposure^63,73	Off-label administration Loewenthal 2010⁶⁷: Inject over 3 to 5 min Mendelson 1976⁶⁸: Inject over 3 to 5 min using Soluset system Meunier 1987⁶⁹: Inject over <1 min Scott 1989⁷⁰: Inject over 5 min	Loewenthal 2010⁶⁷: Described IV push administration of gentamicin and tobramycin in OPAT setting, report of 5593 doses Mendelson 1976⁶⁸: Compared IV push with 2 h infusion in 63 patients with various infections Meunier 1987⁶⁹: PK study in 10 healthy volunteers that compared IV push with slow IV injection (same dose diluted in 100 mL given over 15 min); authors endorsed slow IV injection administration based on PK parameters (IV push resulted in high peak serum concentrations) Scott 1989²: PK study in 19 patients and 2 healthy volunteers that compared IV push with IM administration Refer to text for additional data with IV push
Tobramycin	Intermittent IV infusion IM Not approved for IV push administration	Off-label preparation Loewenthal 2010⁶⁷: Dilute doses <800 mg to 20 mL with NS; larger doses administered as 40 mg/mL solution supplied in manufacturer’s vials Aoyama 1987⁷⁴: 2 mg/kg dose diluted in 10-mL D5W	Plastic syringe, 40 mg/mL solution from reconstituted 1.2-g vial^63,75: after 2 mo, no significant change in concentration detected at 4°C and 25°C	Off-label administration Loewenthal 2010⁶⁷: Inject over 3 to 5 min Aoyama 1987⁷⁴: IV push, administration time not reported; Injected within 2 to 3 min of preparation	Loewenthal 2010⁶⁷: Described IV push administration of gentamicin and tobramycin in OPAT setting, report of 5593 doses Aoyama 1987⁷⁴: Evaluated different routes of tobramycin administration in 21 burn patients, included IV push (5 patients) Refer to text for additional data with IV push
Carbapenems
Ertapenem	Intermittent IV infusion IM Not approved for IV push administration	Off-label preparation Wiskirchen 2013⁷⁶: Dilute 1 g dose in NS to a total volume of 10 mL (100 mg/mL)	Wiskirchen 2013⁷⁶: Prepared doses used within 6 h of reconstitution; stored under refrigeration until administered Polypropylene syringes, 100 mg/mL in NS^63,77: 30 min at RT, 24 h under refrigeration followed by 4 h at RT, 14 d frozen followed by 5 h at RT, or 28 d frozen followed by 3 h at RT	Off-label administration Wiskirchen 2013⁷⁶: Inject over 5 min, at a rate of 2 mL/min through peripheral IV catheter	Wiskirchen 2013⁷⁶: Evaluated IV push administration in a PK study of 12 healthy volunteers; did not specifically evaluate stability
Meropenem	IV push Intermittent IV infusion	Vials of 500 mg or 1 g: reconstitute with 10-mL and 20-mL SWFI, respectively, to a resulting concentration of 50 mg/mL No further dilution required	Reconstituted vial: 3 h at 25°C and 13 h at 5°C Plastic luer-tip syringes with tubing attached and capped, 50 mg/mL in SWFI⁶⁴: 8 h at RT and 44 h under refrigeration	Inject over 3 to 5 min (adults and children ≥3 months) Children <3 months should receive IV infusion over 30 min
Cephalosporins
Cefazolin	IV push Intermittent IV infusion IM	Vials of 500 mg or 1 g: reconstitute with 2- and 2.5-mL SWFI to resulting concentrations of 225 and 330 mg/mL, respectively Further dilute reconstituted solution with approximately 5 mL of SWFI for IV push administration Off-label preparation McLaughlin 2017, Poole 1999, Garrelts 1988^2,78,79: 1 or 2 g diluted with 10-mL SWFI	Reconstituted vial: 24 h at RT and 10 d under refrigeration Extended stability data⁶³: 500 mg diluted in 2 mL of SWFI⁸⁰: 4 d at 25°C Plastic syringes, 100 and 200 mg/mL in SWFI⁸¹: 13 d at 24°C, 28 d at 4°C, 3 mo when frozen at −15°C (time to 10% loss) Polypropylene syringes, 100 and 200 mg/mL in SWFI⁸²: 30 d at 5°C with light protection, followed by 72 h at 21 to 25°C with light exposure	Inject over 3 to 5 min, directly into vein or through the tubing of a running compatible IV infusion Off-label administration McLaughlin 2017²: Inject over 2 min Poole 1999⁷⁹: Inject over 3 to 5 min Garrelts 1988⁷⁸: Inject over 1 to 2 min/g	McLaughlin 2017²: Evaluated use of IV push for first dose only in ED Poole 1999⁷⁹: Evaluated IV push for patient-administered doses at home (OPAT) Garrelts 1988⁷⁸: Evaluated rates of postinfusion phlebitis with IV push compared with IV infusion in a tertiary hospital
Cefepime	Intermittent IV infusion IM Not approved for IV push administration	Off-label preparation Tran 2017³: 1- and 2-g doses diluted in NS to a total volume of 10 mL McLaughlin 2017²: 1- and 2-g doses diluted in 10 and 20 mL of SWFI, respectively	Reconstituted solutions in compatible solutions: 24 h at 20 to 25°C and 7 d at 2 to 8°C (see PI for further details) Polypropylene syringes, 100 and 200 mg/mL in D5W, NS, or SWFI^63,83,84: 14 d at 4°C, 1 d at RT, and up to 90 d at –20°C	Off-label administration Tran 2017³: Inject over 2 to 5 min McLaughlin 2017²: Inject over 5 min	Tran 2017 and McLaughlin 2017^2,3: Evaluated use of IV push for first dose only in ED An additional study⁸⁵ evaluated 2 g over 3, 5, 10, and 15 min in healthy volunteers; however, concentration was 40 mg/mL (total volume, 50 mL)
Cefotaxime	IV push Intermittent IV infusion IM	Vials of 500 mg, 1 g, and 2 g: reconstitute with 10-mL SWFI to resulting concentrations of 50, 95, and 180 mg/mL, respectively No further dilution required Maximum concentration for IV push is 200 mg/mL in SWFI⁶⁵	Reconstituted vial: 24 h at RT, 7 d under refrigeration, and 13 wk frozen for 500-mg and 1-g vials; 12 h at RT, 7 d under refrigeration, and 13 wk frozen for 2-g vial Plastic syringe, reconstituted solutions for IV push: 5 d under refrigeration and 13 wk frozen	Inject over 3 to 5 min Can be given directly into vein or through the tubing of a running compatible IV infusion^60,63	Do not administer over <3 min; injection over <1 min through a central venous catheter has resulted in life-threatening arrhythmias Maximum IV push concentration only reported in Pediatric Injectable Drugs text
Cefotetan	IV push Intermittent IV infusion IM	Vials of 1 and 2 g: reconstitute with 10-mL and 10- to 20-mL SWFI to resulting concentrations of 95 mg/mL and 95 or 182 mg/mL, respectively No further dilution required	Reconstituted vial: 24 h at 25°C, 96 h at 5°C, and 1 wk at -20°C Plastic or glass syringes, reconstituted solutions for IV push: 24 h at 25°C and 96 h at 5°C	Inject over 3 to 5 min
Cefoxitin	IV push Intermittent IV infusion	Vials of 1 and 2 g: reconstitute with 10-mL SWFI to resulting concentrations of 95 mg/mL and 180 mg/mL, respectively No further dilution required	Reconstituted vials with 1 g/10 mL concentration: 6 h at RT and 1 wk under refrigeration, for all compatible diluents Plastic syringes, 1 and 2 g diluted in 10 mL of SWFI^63,81: 2 d at 24°C, 23 d at 4°C, 3 mo frozen at −15°C (time to 10% loss)	Inject over 3 to 5 min, directly into vein or through the tubing of a running compatible IV infusion Off-label administration McLaughlin 2017²: Inject 1 g dose over 2 min and 2 g dose over 5 min Garrelts 1988⁷⁸: Inject over 1 to 2 min/g	McLaughlin 2017²: evaluated use of IV push for first dose only in ED; both 1 and 2 g doses were diluted in 10 mL SWFI Garrelts 1988⁷⁸: Evaluated rates of postinfusion phlebitis with IV push compared with IV infusion in a tertiary hospital; 1 g dose diluted in 10 mL SWFI
Ceftazidime	IV push Intermittent IV infusion IM	Fortaz vials of 500 mg, 1 g or 2 g: reconstitute with 5.3-, 10-, and 10-mL SWFI to resulting concentrations of 100, 100, and 170 mg/mL, respectively Tazicef vials of 1 or 2 g: reconstitute with 10-mL SWFI to concentrations of 95 and 180 mg/mL, respectively No further dilution required Off-label preparation McLaughlin 2017²: 1 or 2 g diluted with 10 or 20 mL SWFI, respectively	Reconstituted vials for Fortaz (all sizes): 12 h at RT or 3 d under refrigeration; reconstituted solution in original container may be frozen for 3 mo at –20°C Reconstituted vials for Tazicef (all sizes): 24 h at RT or 7 d under refrigeration; reconstituted solution in original container may be frozen for 3 mo at –20°C Polypropylene syringes, 100 and 200 mg/mL in SWFI (Fortaz)^63,86: 8 h at 22°C, 96 h at 4°C, and 91 d at –20°C	Inject over 3 to 5 min, directly into vein or through the tubing of a running compatible IV infusion Off-label administration McLaughlin 2017²: Inject over 5 min Garrelts 1988⁷⁸: Inject over 1 to 2 min/g	McLaughlin 2017²: Evaluated use of IV push for first dose only in ED Garrelts 1988⁷⁸: Evaluated rates of postinfusion phlebitis with IV push compared with IV infusion in a tertiary hospital; 1 g diluted in 10 mL SWFI Specific formulation of ceftazidime in Studies 1 and 2 not reported
Ceftriaxone	Intermittent IV infusion IM Not approved for IV push administration	PI reconstitution Vials of 250 mg, 500 mg, 1 g, and 2 g: reconstitute with 2.4-, 4.8-, 9.6-, and 19.2-mL SWFI, NS, or D5W, respectively, to a resulting concentration of 100 mg/mL (PI recommends further dilution for administration via IV infusion) Off-label preparation McLaughlin 2017²: 1 and 2 g diluted in 10 mL SWFI Poole 1999⁷⁹: 1 g diluted in 10 mL SWFI Garrelts 1988⁷⁸: 1 g diluted in 10 mL SWFI	Reconstituted vials (100 mg/mL): 2 d at 25°C and 10 d at 4°C Polypropylene syringes, 100 mg/mL in SWFI^63,87: 72 h at 20°C; 40 d at 4°C, and 180 d frozen at –20°C	Off-label administration McLaughlin 2017²: Inject over 2 min (adults only) Poole 1999⁷⁹: Inject over 2 to 4 min in those aged >11 years Garrelts 1988⁷⁸: Inject over 1 to 2 min/g (adults only)	McLaughlin 2017²: Evaluated use of IV push for first dose only in ED Poole 1999⁷⁹: Evaluated IV push for patient-administered doses at home (OPAT) Garrelts 1988⁷⁸: Evaluated rates of postinfusion phlebitis with IV push compared with IV infusion in a tertiary hospital
Cefuroxime	IV push Intermittent IV infusion Continuous IV infusion IM	Vials 750 mg and 1.5 g: reconstitute with 8.3- and 16-mL SWFI, respectively, to a resulting concentration of 90 mg/mL No further dilution required Off-label preparation Poole 1999 and Garrelts 1988^78,79: 750 mg diluted with 10 mL SWFI	Reconstituted vials: 24 h at RT and 48 h under refrigeration	Inject over 3 to 5 min, directly into vein or through the tubing of a running compatible IV infusion Off-label administration Garrelts 1988⁷⁸: Inject over 1 to 2 min/g	Poole 1999⁷⁹: Evaluated IV push for patient-administered doses at home (OPAT); over 3 to 5 min Garrelts 1988⁷⁸: Evaluated rates of postinfusion phlebitis with IV push compared with IV infusion in a tertiary hospital No relevant syringe stability was located
Glycopeptides/lipoglycopeptides/lipopeptides
Daptomycin	IV push (adults only) Intermittent IV infusion (adults and pediatric patients aged 1 to 17 years)	Cubicin Cubicin vials: reconstitute with 10 mL of NS to concentration of 50 mg/mL No further dilution required Cubicin RF Cubicin RF vials: reconstitute with 10 mL of SWFI or BWFI to concentration of 50 mg/mL No further dilution required	Cubicin Reconstituted Cubicin vials: 12 h at RT and 48 h under refrigeration Cubicin RF Reconstituted Cubicin RF vials: 24 and 48 h at RT in SWFI and BWFI, respectively; 3 d under refrigeration in both SWFI and BWFI Polypropylene syringes (with elastomeric rubber stopper), 50 mg/mL (Cubicin RF): 24 h and 3 d at RT and under refrigeration, respectively, when diluted with SWFI; 48 h and 5 d at RT and under refrigeration, respectively, when diluted with BWFI	Cubicin and Cubicin RF Inject over 2 min	Cubicin and Cubicin RF Do not administer by IV push in pediatric and adolescent patients aged ≤17 years. 2 formulations are available (Cubicin and Cubicin RF), which have differences in reconstitution and storage Cubicin No relevant syringe stability for Cubicin formulation was located Cubicin RF Do not use saline-based diluents to reconstitute Cubicin RF; this results in hyperosmotic solution that may cause infusion-site reactions when given as IV push
Monobactam
Aztreonam	IV push Intermittent IV infusion IM	Vials of 1 and 2 g: reconstitute with 6- to 10-mL SWFI No further dilution required	Reconstituted solutions >20 mg/mL in SWFI: 48 h at RT and 7 d under refrigeration	Inject over 3 to 5 min, directly into vein or through the tubing of a running compatible IV infusion	No relevant syringe stability was located
Others
Chloramphenicol	IV push	Vials of 1 g: reconstitute with 10 mL of SWFI or D5W to resulting concentration of 100 mg/mL No further dilution required	Reconstituted vial^62,63: 30 d at RT	Inject over at least 1 min	No relevant syringe stability was located
Penicillins
Ampicillin	IV push Slow IV injection IM	Vials of 125, 250, and 500 mg: reconstitute with 5-mL SWFI or BWFI Vials of 1 and 2 g: reconstitute with 7.4 or 14.8 mL, respectively, SWFI or BWFI No further dilution required	IM and IV push injections should be administered within 1 h after reconstitution as potency may decrease Additional stability information in text summary	Inject over 3 to 5 min for 125-, 250-, and 500-mg doses Inject over 10 to 15 min for 1- and 2-g doses	Administration of ampicillin more rapidly than recommended may result in convulsive seizures^c No relevant syringe stability was located
Ampicillin/sulbactam	Slow IV injection Intermittent IV infusion IM	Vials of 1.5 and 3.0 g: Reconstitute with 3.2 or 6.4 mL of SWFI, respectively, to a concentration of 250 mg ampicillin/mL Further dilute with suitable diluent to a final concentration of 30 mg ampicillin/mL (maximum concentration for IV administration)	Reconstituted solution (30 mg ampicillin/mL), in SWFI or NS: 8 h at 25ºC and 48 h at 4ºC	Inject over at least 10 to 15 min	See PI for detailed information on stability for various diluents and storage conditions No relevant syringe stability was located
Nafcillin	Slow IV injection Intermittent IV infusion IM	Vials of 1 or 2 g: reconstitute, respectively, with 3.4 or 6.6 mL SWFI, NS, or BWFI (with benzyl alcohol or parabens) to final concentration of 250 mg/mL Further dilute reconstituted solution with at least 15 to 30 mL SWFI, NS, or ½ NS Off-label preparation Poole 1999⁷⁹: 1 g diluted with 25 mL NS (for central line administration only)	Initial reconstituted solution (250 mg/mL): 3 d at RT, 7 d under refrigeration, and 90 d frozen Stability of further diluted solutions: 10 to 200 mg/mL: 24 h at RT and 7 d under refrigeration, in SWFI and NS	Inject over 5 to 10 min, recommended to be given through the tubing of a running compatible IV infusion	Poole 1999⁷⁹: Evaluated IV push for patient-administered dose at home (OPAT); given over 5 to 10 min No relevant syringe stability was located
Oxacillin	Slow IV injection Intermittent IV infusion IM	Vials of 1 and 2 g: Reconstitute with 10 or 20 mL, respectively, of SWFI, ½ NS, or NS to 100 mg/mL No further dilution required	Reconstituted solution (10-100 mg/mL): 4 d at RT and 7 d under refrigeration, in SWFI and NS Reconstituted solution (100 mg/mL): 30 d frozen in SWFI and NS (for SWFI, includes 50-100 mg/mL) Plastic luer-tip syringes with tubing attached and capped, 100 mg/mL in NS⁶⁴: 92 h at RT and 2 wk under refrigeration	Inject over 10 min
Polymyxins
Colistimethate sodium	IV push IV continuous infusion IM injection	150 mg vial: reconstitute with 2 mL SWFI to resulting concentration of 75 mg/mL No further dilution required	Reconstituted vial: 7 d at refrigerated (2°-8°C) or RT (20°-25°C)	Inject over 3 to 5 min	See text summary for additional stability information No relevant syringe stability was located

Note. FDA = Food and Drug Administration; ½ NS = half-normal saline (0.45% sodium chloride); D5W = dextrose 5% in water; OPAT = outpatient parenteral antibiotic therapy; ED = emergency department; IM = intramuscular; IV = intravenous; NS = normal saline (0.9% sodium chloride); PI = prescribing information; PK = pharmacokinetic; RT = room temperature; SWFI = sterile water for injection; BWFI = bacteriostatic water for injection; USP = United States Pharmacopeia.

Information sourced from PI unless otherwise noted.

For assigning beyond use dates, in addition to stability data, USP <797> recommendations for sterility still apply. The shorter of the times should be used.

Clinical Pharmacology reported 100 mg/min as maximum rate; however, this information could not be confirmed in additional resources. In addition, this rate is slower than what would be administered if following PI-recommended dilution and administration.