Antibiotic IV Administration During COVID-19

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Intravenous (IV) Antibiotic administration Quick Reference – Guide COVID-19 escalation

- Antibiotics are critical medicines and should be given within 1 hour of sepsis diagnosis.
- Please endeavour to take blood cultures before IV antibiotics are administered.
- During COVID-19 pandemic, bolus administration (where possible) and use of gravity infusions (using drip rate count and no pump) may become necessary.
BOLUS possible: Amoxicillin, Benzylpenicillin (only 1.2g dose), Ceftriaxone (only 1g dose), Cefuroxime, Co-amoxiclav, Flucloxacillin, Gentamicin,
Teicoplanin
Gravity infusion possible: Amoxicillin, Benzylpenicillin, Ceftriaxone, Cefuroxime, Ciprofloxacin, Clarithromycin, Co-amoxiclav, Flucloxacillin,
Gentamicin, Meropenem, Metronidazole, Piperacillin/Tazobactam (Tazocin), Teicoplanin, Tigecycline
Method of administration
Bolus ` Gravity True allergic
Antibiotic Name Dose IV injection IV Infusion infusion reactions:

Allergy Key
possible? Non-severe;
Yes/No rash
Over 3 - 5 minutes Calculate Severe;
(unless stated otherwise) drip rate angioedema,
Use
anaphylaxis
calculator

Amoxicillin 1g BOLUS  Add required volume of reconstituted Yes This is a


Reconstitute with 20mL WFI solution to penicillin
Check allergy
 100mL sodium chloride 0.9% status!
 Give over 30 minutes

Benzylpenicillin 1.2g BOLUS  Reconstitute each 1.2g vial with at Yes This is a
Reconstitute with at least 8ml WFI or least 8ml WFI penicillin
sodium chloride 0.9 %  Add required volume of reconstituted Check allergy
Withdraw contents of vial and further solution to 100ml sodium chloride status!
dilute to final volume of 20ml 0.9%
Give over 5 minutes  Give over 30 – 60 minutes
2.4g DO NOT BOLUS – IV infusion only
Ceftriaxone 1g BOLUS  Use 20ml of infusion fluid to Yes Cross reactivity
with penicillins
Reconstitute 1g vial with 10ml sodium reconstitute the 2g vial
chloride 0.9%  Add the reconstituted solution back to If true severe
Give over 5 minutes the bag of allergy – DO NOT
 100ml sodium chloride 0.9% GIVE
 Give over 30 – 60 minutes

Key: WFI = Water For Injection


Red – penicillin allergy. CONTRAINDICATED
Amber – penicillin allergy. Avoid if serious allergy. Use with caution if non-severe allergy and no alternative
Green – penicillin allergy. Considered safe
Intravenous Antibiotic administration Quick Reference guide v1 March 2020 (EH) Approved by MGG April 2020
References: Injectable Medicines Guide (Medusa), Summary of medicine Products Characteristics (SmPC, accessed via medicines.org.uk), Specialist Pharmacy Service https://www.sps.nhs.uk/articles/use-of-
gravity-infusions-and-bolus-injections-in-adults-during-covid-19/ (3/04/2020 version)
Intravenous (IV) Antibiotic administration Quick Reference Guide
Antibiotic Name Dose BOLUS Gravity True allergic
IV injection IV Infusion infusion reactions:

Allergy Key
possible? Non-severe;
Over 3 - 5 minutes Yes/No rash
(unless stated otherwise) Severe;
angioedema,
anaphylaxis

Cefuroxime 1.5g BOLUS  Add the reconstituted solution to Yes Cross reactivity
with penicillins
Reconstitute with 15ml WFI 100ml sodium chloride 0.9%
 Give over 30 – 60 minutes If true severe
allergy – DO NOT
GIVE

Ciprofloxacin  Available as ready to use infusion Yes


Ciprofloxacin has excellent DO NOT BOLUS – IV infusion only AVOID
oral bioavailability. If oral (via large peripheral vein)  Give 400mg (200ml) over 60 minutes IN
route available consider EPILEPSY
using.
(tablets can be crushed and  Give 200mg (100ml) over 30 minutes can lower
dispersed in WFI for NG/PEG seizure
admin) threshold

Clarithromycin  Reconstitute with 10ml WFI Yes


DO NOT BOLUS – IV infusion only  Shake vial to dissolve contents
(via large peripheral vein)  Add reconstituted solution to 250ml
sodium chloride 0.9%
 Give over 60 minutes

Co-amoxiclav 1.2g BOLUS  Add reconstituted solution to Yes This is a


Reconstitute 1.2g vial with 100ml sodium chloride 0.9% penicillin
20ml WFI  Give over 30 minutes Check allergy
status!
Flucloxacillin 1g BOLUS  Add reconstituted solution to Yes This is a
Reconstitute with 20ml WFI 100ml sodium chloride 0.9% penicillin
Give over 3 minutes  Give over 30 – 60 minutes Check allergy
2g BOLUS status!
Reconstitute with 40ml WFI
Give over 6 minutes

Key: WFI = Water For Injection


Intravenous Antibiotic administration Quick Reference guide v1 April 2020 (LB/RH/EH/AN) Approved by MGG April 2020
Intravenous (IV) Antibiotic administration Quick Reference Guide
Antibiotic Name Dose BOLUS Gravity True allergic
IV injection IV Infusion infusion reactions:

Allergy Key
possible? Non- severe;
Over 3 - 5 minutes Yes/No rash
(unless stated otherwise) Severe;
angioedema,
anaphylaxis

Gentamicin All doses* BOLUS  Add required dose to 100ml sodium Yes
Can administer undiluted chloride 0.9% Gentamicin
Click HERE or  Give over 20 – 30 minutes *MUST NOT*
(Aintree site) dilute with 10 – 20ml sodium
be used in
chloride 0.9%
Click HERE patients
(Royal site) .!.Gentamicin levels are NOT for STAT dose only (and drug is not to with
continue) Myasthenia
for the gentamicin
Gravis
dosing calculatorIf gentamicin is to continue: (see site-specific policy)
*Maximum LEVELS must be checked (MG)
450mg once Daily U&Es taken
daily* And refer patient to pharmacy for follow up of levels
 Level 8-12 hours after first dose (all wards, except critical care)
 2 levels for critical care patients (1 hour and 6 hours post dose)
Levofloxacin DO NOT BOLUS – IV infusion only  Available as ready to use infusion No AVOID
Levofloxacin has excellent (via large peripheral vein)  Give 500mg (100ml) over 60 minutes IN EPILEPSY
oral bioavailability. If oral  Give 250mg (50ml) over 30 minutes Can lower
route is available consider
seizure threshold
using.
Meropenem IV infusion preferred  Reconstitute 1g vial with 20ml WFI Yes Cross reactivity
BOLUS possible  Shake vial to dissolve contents with penicillins
Reconstitute 1g vial with 20ml WFI  Add reconstituted solution to 100ml
Shake vial to dissolve contents (until solution is sodium chloride 0.9% If true severe
allergy – DO NOT
clear)  Give over 15 – 30 minutes GIVE
Give over 5 minutes
Metronidazole  Available as ready to use infusion Yes
Metronidazole has excellent DO NOT BOLUS – IV infusion only (100ml)
oral bioavailability. If oral  Give over 20 – 30 minutes
route available consider
using. Suspension available
for NG.

Key: WFI = Water For Injection


Intravenous Antibiotic administration Quick Reference guide v1 April 2020 (LB/RH/EH/AN) Approved by MGG April 2020
Intravenous (IV) Antibiotic administration Quick Reference Guide
Antibiotic Name Dose BOLUS Gravity True allergy

Allergy Key
IV injection IV Infusion infusion reactions
possible? include:
Over 3 - 5 minutes Yes/No rash,
(unless stated otherwise) angioedema,
anaphylaxis

Piperacillin/  Reconstitute with 20ml WFI Yes This is a


IV infusion preferred penicillin
tazobactam  Swirl until dissolved. Check allergy
(Tazocin)  Add reconstituted solution to status!
BOLUS (unlicensed use); 100ml sodium chloride 0.9%
Reconstitute with 20ml WFI. Swirl until dissolved.
 Give over 30 minutes
Give over 5 minutes

Teicoplanin 200mg – 1200mg BOLUS  Slowly add ampoule of WFI provided Yes Patient needs
doses* to vial a twice daily
Slowly add ampoule of WFI  Gently roll vial to dissolve. Avoid loading dose
Dose based on weight provided to vial foam formation. for 2 days
and renal function – see
formulary  DO NOT shake. If solution becomes before
Gently roll vial to dissolve. foamy allow to stand for 15 mins to once daily
Avoid foam formation, allow foam to subside. maintenance
DO NOT shake. If solution  Add reconstituted solution to dose
becomes foamy allow to 100ml sodium chloride 0.9% CLICK HERE
stand for 15mins to allow  Give over 30 minutes for dosing
foam to subside. advice
Above 1200mg DO NOT BOLUS – IV
infusion only
Tigecycline  Reconstitute each 50mg vial with Yes . Loading dose
DO NOT BOLUS – IV infusion only 5.3mL sodium chloride 0.9% (100mg)
 Add reconstituted solution to needed,
100ml sodium chloride 0.9% followed by
 Give over 30 – 60 minutes 50mg twice
daily

Flushing advice: all the antibiotics listed above are to be flushed with sodium chloride 0.9% or glucose 5%

Key: WFI = Water For Injection


Intravenous Antibiotic administration Quick Reference guide v1 April 2020 (LB/RH/EH/AN) Approved by MGG April 2020
Intravenous (IV) Antibiotic administration Quick Reference Guide
Additional supplement: Administration of IV fluids and drugs by gravity
infusion (drip rate calculation) where a pump is not available
There may be a shortage of infusion pumps and syringe pumps during the COVID-19
pandemic.
 IV antibiotics should be given as a bolus if safe to do so.
 Selected IV medicines and IV fluids may be safely given via gravity infusion (see table
above) or access the electronic IV injectable guide (medusa).
1. Check table above to see if drug can be given by gravity infusion.
2. Establish the volume of the infusion in millilitres (taking into account any additions made
to the bag) and the desired length of infusion in minutes.
3. Drip factor is usually 20 drops per millilitre (ml)
(Check manufacturer’s drip factor on the package of the giving set)
Warning: do not use this calculator for the drip rate of a blood/blood products
4. Calculate the rate of the infusion in drops per minute using the equation (or use the
online calculator on the nurse webportal):

Alternatively see table 1 for the rate of infusion in drops per minute for most commonly
used volumes and infusion times.
5. Open the roller clamp and count the number of drops per minute (or number of drops in
15 or 30 seconds and multiply by two or four accordingly). Adjust accordingly to the
desired number of drops.
6. Monitor drop rate frequently throughout the duration of the infusion to maintain the
desired infusion rate.
Table 1 Drip rate for common infusion volumes/times (*drugs with a drip factor of approx.20 drops/
mL)

Volume Time to be Drops Drops Drops


infused over per minute per 30 per 15
seconds seconds

1000 mL 12 hours 28 14 7

1000 mL 8 hours 42 21 10

1000 mL 4 hours 83 42 21

500 mL 8 hours 21 10 5

500 mL 4 hours 42 21 10

500 mL 2 hours 83 42 21

250 mL 2 hours 42 21 10

250 mL 1 hour 83 42 21

100 mL 1 hour 33 17 8

100 mL 30 minutes 67 33 17

50 mL 30 minutes 33 17 8

Key: WFI = Water For Injection


Intravenous Antibiotic administration Quick Reference guide v1 April 2020 (LB/RH/EH/AN) Approved by MGG
April 2020

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