Anti-Infective Administration Methods

This document serves as a guide, to be used in conjunction with the OCH Vesicant and Irritant List. This information is not a substitute for clinical judgment.

Generic Name Administration IV Access Infusion Time Special Considerations

(Brand Name) Methods C = Central
M=Midline
P= Peripheral
Acyclovir  Elastomeric C, M, P 60 mins[1] Central line preferred.
(Zovirax)  MB Precipitate will dissolve at room temperature; potency of drug and
chemical stability is not affected
Amikacin  Elastomeric C 30-60 mins[1] Peak, trough
(Amikin)  MB Monitor for Ototoxicity. Long term patients should have baseline
audiogram and then every 2-3 weeks

Amphotericin B  Elastomeric C, M, P 4-6 hrs[1] Central line preferred.

(Fungizone)  MB Vascular access devices should be flushed with DEXTROSE, followed
 Pump I by heparin or saline, as required for the individual device.

Amphotericin B Lipid  Polyolefin bag C, M, P 2.5mg/kg/hr Central line preferred.

Complex Vascular access devices should be flushed with DEXTROSE, followed
(Abelcet) by heparin or saline, as required for the individual device.

Amphotericin B-Liposomal  Elastomeric C, M, P 60-120 mins[1] Central line preferred.

(Ambisome)  MB Vascular access devices should be flushed with DEXTROSE, followed
 Pump I by heparin or saline, as required for the individual device.
Ampicillin  MB C, M, P 3-5 mins (125-500 Central line preferred.
 MB+ mg) [1]
 Pump C
 Elastomeric 10-15 mins (1-2 g) [1]
 Elast C
Continuous
Ampicillin-sulbactam  Elastomeric (not C, M, P 10-15 mins slow inj[3] Central line preferred.
(Unasyn) for continuous) RT stability data does not support 24h continuous via elastomeric.
 MB 15-30 mins [3]
 MB+
 Pump C Continuous

Anidulafungin (Eraxis)  Kit for home C, M, P 3 hrs No data for MB+

preparation
Azithromycin  Elastomeric C, M, P 60 mins[3]
(Zithromax)  MB

Administration Method Key

IVP: IV Push H: Homepump Elast C: Continuous Pump I: Pump Pump C: Pump MB: Mini bag with flow MB+: Mini bag plus with flow AIP: Ambulatory infusion
E: Easypump elastomeric Intermittent continuous rate controller rate controller pump (Curlin or CADD)
S: SMARTez
OCH Anti-Infective Administration Methods – December 2021 1 ©2021 Option Care. All rights reserved.
Generic Name Administration IV Access Infusion Time Special Considerations
(Brand Name) Methods C = Central
M=Midline
P= Peripheral
Aztreonam  Elastomeric C, M, P 3-5 mins IVP[3]
(Azactam)  IVP 20-60 mins [3]
 MB
 MB+
Caspofungin  Elastomeric C, M, P 60 mins[3]
(Cancidas)  MB
 MB+
Cefazolin  IVP C, M, P 3-5 mins IVP[1]
(Ancef)  Elastomeric 30-60 mins [1]
 Elast C ELAST C 24 hrs

Cefiderocol (Fetroja)  MB (Kit/home mix) C, M, P 3 hours

Cefepime  IVP C, M, P 3-5 mins IVP[3] Caution in patients with neutropenia at baseline.
(Maxipime)  Elastomeric 30 mins [3]
 Elast C 3-4 hrs (extended)[3] Monitor for increased risk of nephrotoxicity and leukopenia if given
with vancomycin.
Cefotaxime  IVP C, M, P 3-5 mins IVP[3]
(Claforan)  Elastomeric 15-30 mins[3]
 MB
 MB+
Ceftaroline fosamil  MB C, M, P 5-60 mins[3]
(Teflaro)  MB+

Ceftazidime  IVP C, M, P 15-30 mins[3]

(Fortaz, Tazicef)  Elastomeric Continuous
 Elast C
 MB
 MB+
Ceftazidime-avibactam  MB C, M, P 2 hrs [3]
(Avycaz)  MB+
Ceftolozane -Tazobactam  Elastomeric C, M, P 1 hr [3]
(Zerbaxa)  MB
 MB+

Administration Method Key

IVP: IV Push H: Homepump Elast C: Continuous Pump I: Pump Pump C: Pump MB: Mini bag with flow MB+: Mini bag plus with flow AIP: Ambulatory infusion
E: Easypump elastomeric Intermittent continuous rate controller rate controller pump (Curlin or CADD)
S: SMARTez
OCH Anti-Infective Administration Methods – December 2021 2 ©2021 Option Care. All rights reserved.
Generic Name Administration IV Access Infusion Time Special Considerations
(Brand Name) Methods C = Central
M=Midline
P= Peripheral
Ceftriaxone  IVP C, M, P IVP[3]:
(Rocephin)  Elastomeric 1g: 3-5 mins
 MB 2g: at least 10min

30 mins[3]
Cefuroxime (Zinacef)  IVP C, M, P 3-5 mins IVP[3]
 Elastomeric 15-30 mins[3]
 MB
Cidofovir  MB C, M, P 60 mins[2] Hazardous Drug Precautions
(Vistide) Probenecid and hydration orders needed. CBC, BUN, sCr, urine
protein

Ciprofloxacin  Elastomeric C, M, P 60 mins[3] Central line preferred.

(Cipro)  MB
Clindamycin (Cleocin)  Elastomeric C, M, P 10-60 mins[3]
 MB
Dalbavancin (Dalvance)  MB C, M, P 30 min. [3] Incompatible with saline. Limited stability (48 hour).

Daptomycin (Cubicin)  IVP C, M, P 2 mins IVP[2] CPK

 Elastomeric 30 mins [2] Monitor STATIN use. May need to hold statin until patient
completes therapy

Doripenem  Elastomeric C, M, P 60 mins[3]

(Doribax)  MB

Eraxis  Kit for home C, M, P 3 hrs

(anidulafungin) preparation

Ertapenem  MB C, M, P 30 mins[2] Longer stability dating with MB than elastomeric

(Invanz)  MB+
 Elastomeric
Fetroja  MB (Kit/home mix) C, M, P 3 hrs
(cefiderocol)

Fluconazole  Elastomeric C, M, P 60-120 mins[3] Max 200 mg/hr

(Diflucan)  MB

Ganciclovir  Elastomeric C, M, P 60 mins [2] Central line preferred.

(Cytovene)  MB Hazardous Drug Precautions

Administration Method Key

IVP: IV Push H: Homepump Elast C: Continuous Pump I: Pump Pump C: Pump MB: Mini bag with flow MB+: Mini bag plus with flow AIP: Ambulatory infusion
E: Easypump elastomeric Intermittent continuous rate controller rate controller pump (Curlin or CADD)
S: SMARTez
OCH Anti-Infective Administration Methods – December 2021 3 ©2021 Option Care. All rights reserved.
Generic Name Administration IV Access Infusion Time Special Considerations
(Brand Name) Methods C = Central
M=Midline
P= Peripheral
Gentamicin  MB C 30 to 120 min.[2] Pk and Troughs. Monitor for Ototoxicity
 Elastomeric

Ibalizumab-uiyk  MB C, M, P At least 30m Flush line with 30-50ml NS.

(Trogarzo) (loading dose)[3]
At least 15 m
(maintenance)[3]
Imipenem-clilastin  MB C, M, P 20-60 mins[2] Central line preferred.
(Primaxin)  MB+ 3 hrs (extended)
 Elastomeric
Levofloxacin  MB C, M, P 60-90 mins [2,3]
(Levaquin)  Elastomeric
Linezolid  MB C, M, P 30-120 mins[2] Monitor for Thrombocytopenia
(Zyvox)
Meropenem  MB C, M, P 15-30 mins[3] Monitor for seizures
(Merrem)  MB+ 3-5 mins IVP[3]
 Elastomeric >3 hrs (extended)[3]
12h for continuous
Meropenem-vaborbactam  MB C, M, P 3 hr [3]
(Vabomere)  Elastomeric

Merrem (Meropenem)  MB C, M, P 15-30 mins[3] Monitor for seizures

 MB+ 3-5 mins IVP[3]
 Elastomeric >3 hrs (extended)[3]
12h for continuous

Micafungin  MB C, M, P 60 mins[2]
(Mycamine)  MB+
 Elastomeric
Nafcillin  Elastomeric C, M, P 30-60 mins [2] Central line preferred.
 Elast C 10 mins IVP[2]
 MB Continuous Infusion
 Pump I, C

Administration Method Key

IVP: IV Push H: Homepump Elast C: Continuous Pump I: Pump Pump C: Pump MB: Mini bag with flow MB+: Mini bag plus with flow AIP: Ambulatory infusion
E: Easypump elastomeric Intermittent continuous rate controller rate controller pump (Curlin or CADD)
S: SMARTez
OCH Anti-Infective Administration Methods – December 2021 4 ©2021 Option Care. All rights reserved.
Generic Name Administration IV Access Infusion Time Special Considerations
(Brand Name) Methods C = Central
M=Midline
P= Peripheral
Nuzyra (Omadacycline) IV Formulation C, M, P LD: 60 minutes
 MB+ MD: 30 minutes
 Elastomeric
Oral
 Tablets
Oritavancin (Orbactiv,  MB C, M, P 1 hr (Kimyrsa)
Kimyrsa) 3 hr (Orbactiv)

Omadacycline IV Formulation C, M, P LD: 60 minutes

(Nuzyra)  MB+ MD: 30 minutes
 Elastomeric
Oral
 Tablets
Oxacillin  Elastomeric C, M, P 30 mins [2]
 Elast C 10 min IVP[2]
 MB Continuous Infusion
 Pump I, C

Penicillin G Potassium  MB C, M, P 24 hrs[1] Every million units contains 1.7 mEq of Potassium
 Elastomeric 30 mins[1]
 Pump C Continuous

Piperacillin-tazobactam  MB C, M, P 30 mins[2] Nephrotoxicity increases when given with vancomycin.

(Zosyn)  Elastomeric 4 hrs [2] (extended) Increase monitoring of creatinine to twice a week
 Elast C Continuous

Quinupristin-dalfopristin  Elastomeric C, M, P 60 mins[3] Central line preferred.

(Synercid)  MB

Telavancin  Elastomeric C, M, P 60 mins[3] Pregnancy Test

(Vibativ)  MB
 MB+

Tigecycline (Tygacil)  MB C, M, P 30-60 mins[2]

Tobramycin  MB C 20 to 60min[2, 3] Pk and trough

(Nebcin)  Elastomeric

Administration Method Key

IVP: IV Push H: Homepump Elast C: Continuous Pump I: Pump Pump C: Pump MB: Mini bag with flow MB+: Mini bag plus with flow AIP: Ambulatory infusion
E: Easypump elastomeric Intermittent continuous rate controller rate controller pump (Curlin or CADD)
S: SMARTez
OCH Anti-Infective Administration Methods – December 2021 5 ©2021 Option Care. All rights reserved.
Generic Name Administration IV Access Infusion Time Special Considerations
(Brand Name) Methods C = Central
M=Midline
P= Peripheral
Trogarzo  MB C, M, P At least 30m Flush line with 30-50ml NS.
(Ibalizumab-uiyk) (loading dose)[3]
At least 15 mins
(maintenance)[3]
Unasyn  Elastomeric (not C, M, P 10-15 mins slow Central line preferred.
(Ampicillin/Sulbactam) for continuous) injection[3] RT stability data does not support 24h continuous via elastomeric.
 MB+
 Pump C 15-30 mins [3]

Continuous
Vabomere (Meropenem-  MB C, M, P 3 hr [3]
vaborbactam)  Elastomeric

Vancomycin  MB C, M, P(short- 60-120 mins[3] Varies Trough levels.

(Vancocin)  Elastomeric term) depending on dose Monitor creatinine twice a week for patients greater than 55y

Zosyn  MB C, M, P 30 mins[2] Nephrotoxicity increases when given with vancomycin.

(Piperacillin-tazobactam)  Elastomeric 4 hrs [2] (extended) Increase monitoring of creatinine to twice a week
 Elast C Continuous

Zovirax  Elastomeric C, M, P 60 mins[1] PIV not recommended, avoid extravasation. Precipitate will
(Acyclovir)  MB dissolve at room temperature; potency of drug and chemical
stability is not affected
Zyvox  MB C, M, P 30-120 mins[2] Monitor for Thrombocytopenia
(Linezolid)  Elastomeric

Resources:
1. Bing CD, Norobilski-Vasilios A, Bernieri G, et al. Extended Stability for Parenteral Drug. 6th ed. Bethesda, MD: American Society of Health-System Pharmacist; 2017
2. ASHP® Injectable Drug Information™ 2021
3. Lexicomp. Wolters Kluwer. Hudson, OH. Available at: https://online.lexi.com. Accessed July 11, 2021
4. Phelps SJ, Hagemann TM, Lee LR, et al. The Teddy Bear book: Pediatric Injectable Drugs. 10th ed. Bethesda, MD: American Society of Health-System Pharmacist; 2013

Administration Method Key

IVP: IV Push H: Homepump Elast C: Continuous Pump I: Pump Pump C: Pump MB: Mini bag with flow MB+: Mini bag plus with flow AIP: Ambulatory infusion
E: Easypump elastomeric Intermittent continuous rate controller rate controller pump (Curlin or CADD)
S: SMARTez
OCH Anti-Infective Administration Methods – December 2021 6 ©2021 Option Care. All rights reserved.