Antibiotic infusion rate

[dchz]

If I push 100 mcg of phenylephrine I would expect more of a response than if I diluted it and peppered it in over the course of 10 mins. Maybe it's voodoo when it comes to Clinda but I've heard about it enough times that I'm happy to water it down.

I have heard it enough with clinda and i water it down every time as well. But again, my goal here is knowledge for knowledge's sake.

I think the alpha phase elimination of phenylephrine (~5 mins) is very significant compared to the infusion time (10 minutes in your example).

But for elimination of clindamycin (94% protein bound, half life elimination of 3 hours) when compared to infusion time (let's be generous and say 30 mins) makes the infusion time (or IV push time) much less significant theoretically.

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[dchz]

A Marine’s Private War
Unclear if Clinda was the issue. More data needed.

Finally got around to reading this, i can't say for sure, but it really sounded like anaphylaxis here... esmolol to treat tachycardia? no mentions of blood pressure...

either way, academically, this really doesn't convince me of clindamycin causing cardiac death.

But in practice i'm still infusing it in a 250cc bag....

 

[Psai]

So this topic has me thinking lately. I've been taught a few times that pushing clinda leads to dead kidneys, I followed up and no renal issues with any patients yet. I'm wondering if it's just another academic myth. I looked it up and all I can find is a low quality paper from china about how clinda can cause interstitial nephritis and aki but I don't see anything legitimate. The walter reed case smells suspiciously like anaphylaxis as noted above.

I still do vanc infusions slowly, over 60 minutes. I have still had a few patients react to vanc anyway which responded to steroids, antihistamines and iv fluids, likely an allergic reaction. Flagyl comes in a bag, I just run it in quickly without issues. I also think that gentamycin toxicity is related to total dose rather than infusion rate.