Beta-Lactam Intravenous Push Use in a Critical Care Setting: Practice Patterns and Perspectives

Introduction: Amid ongoing intravenous fluid shortages, intravenous push (IVP) administration has increasingly been adopted as an alternative to traditional infusion methods. While IVP offers logistical advantages, recent studies in critically ill populations have raised concerns of increased treatment failure. The extent to which IVP is utilized across different beta-lactam antibiotics remains unclear. The purpose of this study is to understand current practice patterns and perspectives for IVP administration of beta-lactams.


Methods: A Qualtrics survey was distributed in March 2025 to members of the ACCP Critical Care and Infectious Diseases Practice and Research Networks, remaining open for four weeks. The survey assessed institutional practices for administering 11 commonly used beta-lactam antibiotics. The primary outcome was the frequency of IVP use in a critical care setting. Secondary outcomes included the rationale for IVP, profession advocating for IVP, perceptions of appropriateness, and in-house evaluations conducted.


Results: There were 148 respondents, largely from academic medical centers (45.9%) and community teaching hospitals (26.4%). IVP was most frequently reported for cefazolin (46%) and ceftriaxone (41%) and was least commonly used for cefepime (16%), ertapenem (17%), and meropenem (7%). Pharmacists were the primary advocates for IVP (43.2%), followed by nurses (20.9%). The primary reasons for IVP use were fluid shortages, fluid-sparing strategies, and ease of preparation/administration. When asked to rate the appropriateness of IVP outside of the first dose (scale of 0-100), the median rating was 30 (IQR 20-50). Within their institutions, 35 (23.6%) had evaluated IVP for safety, efficacy, and/or cost-savings.


Conclusions: Despite evidence supporting prolonged infusion of various beta-lactams, IVP administration is commonly utilized, with usage varying by agent. While pharmacists are the primary advocates for IVP, many believe it is inappropriate in a critical care setting, though few have conducted formal evaluations. These findings highlight the need to further explore additional considerations for IVP administration of beta-lactams in this setting, such as institutional policies, drug characteristics, and formal evaluations of safety and efficacy.