Rethinking Antibiotic Delivery: Clinical Outcomes of IV Push Compared With IV Piggyback Infusions

Introduction: Intravenous (IV) fluid shortages have significantly impacted administration of IV medications, particularly antibiotics (ABX). Small-volume IV push (IVP; 5-20 mL over 3-5 minutes) has become increasingly common in place of traditional Intravenous piggyback (IVPB; 50-100 mL over 30–60 minutes). Excessive fluids may exacerbate heart failure, cirrhosis, electrolyte imbalances (EI) and prolong hospitalization. IVP minimizes fluids yet its impact on clinical outcomes is unclear. Our purpose is to assess differences in adverse events (AE), medication errors, EI, and readmission rates associated with administration of common ABX.


Methods: This retrospective cohort study analyzed patients’ electronic medical records at Olive View-UCLA Medical Center to determine eligibility. Inclusion criteria: patients ≥ 18 years admitted between January - October 2024 and received IVPB ABX or from November 2024 to May 2025 and received IVP ABX, with ≥24 hours of therapy. Patients were excluded if they were on IV ABX or diuretic prior to admission, had pre-existing EI, or renal disease. Primary outcome included patient tolerability, electrolyte abnormalities, fluid exacerbation-related readmission rates and diuretic use compared between IVPB and IVP cohorts. Data analysis involved descriptive statistics, Chi-square or Mann-Whitney U.


Results: From 2854 patients and 3280 unique ABX courses screened, 324 patients with 332 ABX courses met inclusion. Baseline characteristics: age, gender, ethnicity, preexisting heart and liver failure were similar between IVPB (n=202) vs IVP (n=130) groups. Primary outcomes including AE, recurrent infection rates, electrolytes imbalance, fluid-exacerbation–related readmission rates, medication errors, and diuretic use were similar in both cohorts. ABX given via IVP were associated with significantly less mean volume (50 vs 600mL, p< 0.0001). Total length of stay was longer with IVPB compared to IVP (median 5 vs 2 days, p=0.014).


Conclusions: IVP may provide ease of administration without compromising efficacy, tolerability, and safety for certain antibiotics. These findings support IVP as a viable strategy in the setting of IV fluid shortages and may inform institutional policies for ABX delivery. Further research is needed to assess long-term clinical outcomes and cost-effectiveness.