• Ann Tran, David O'Sullivan, and Michelle Krawczynski.
• 1 Department of Pharmacy Services, Hartford Hospital, Hartford, CT, USA.
• J Pharm Pract. 2018 Dec 1; 31 (6): 605-609.

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.

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