Cefepime Intravenous Push Versus Intravenous Piggyback on Time to Administration of First-Dose Vancomycin in the Emergency Department

J Pharm Pract. 2018 Dec;31(6):605-609. doi: 10.1177/0897190017734442. Epub 2017 Oct 18.


Study objective:: The combination of cefepime and vancomycin is commonly used as an empiric antimicrobial regimen. Time to first-dose antibiotics is associated with survival benefit. The objective of this study is to evaluate whether cefepime intravenous push (IVP) is associated with a shorter time to vancomycin administration in the emergency department (ED) compared with cefepime intravenous piggyback (IVPB) infusion.

Methods:: This was a retrospective chart review of records of patients who were treated with the vancomycin-cefepime combination in the ED.

Results:: A total of 1071 charts from April 2013 to January 2015 were reviewed. Included in the pre-(IVBP) group was 536 subjects and 535 subjects in the post-(IVP) group. The indications for antibiotic therapy were sepsis alone (28.3%), pneumonia alone (30.7%), sepsis with pneumonia (36.5%), and other (4.6%). The median time from administration of cefepime to vancomycin were 63.5 minutes and 2.0 minutes in the IVPB and IVP cohorts, respectively ( P < .001).

Conclusion:: The use of first-dose cefepime IVP in the ED resulted in a statistically significant decrease in time to vancomycin administration of over 1 hour.

Keywords: cefepime; emergency medicine; empiric antibiotics; medication administration methods.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage*
  • Cefepime / administration & dosage*
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Infusions, Intravenous
  • Infusions, Parenteral
  • Injections, Intravenous
  • Male
  • Middle Aged
  • Retrospective Studies
  • Vancomycin / administration & dosage*


  • Anti-Bacterial Agents
  • Vancomycin
  • Cefepime