Ampicillin/Cefotaxime in Febrile Neonate

  1. Hi,

    In the ER where I work I am usually assigned to the Pediatric area, which i love! I have been a nurse for less than a year, so I am hoping that I can get an answer from someone who knows more than I do!

    We have a protocol for the Febrile Neonate, and after the IV, blood, and Lumbar puncture, we give Ampicllin and Cefotaxime. My question is regarding how fast you administer these. I have been told two separate things. One is to give the ampicillin IVP over 3-5 minutes and the Cefotaxime over an hour, and the other is to give the Cefotaxime IVP over 3-5 minutes and the Ampicillin over an hour. What do you normally do? The books I look at go either way.
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    About luckylucyrn

    Joined: May '06; Posts: 126; Likes: 26
    Registered Nurse
    Specialty: 2 year(s) of experience in Emergency Department


  3. by   prmenrs
    We just push them. DILUTE them--they're hard on the veins.

    I'm moving your post to NICU forum where it can get more input.
  4. by   LoveTheNICU
    In my NICU, we run Amp over 5-10 minutes on a syringe pump, followed by a flush over 5 minutes. If the volume is less than 1 ml, some nurses will push the med very slowly and and run a flush over 5-10 minutes. Claforan (cefotaxime) we run over 10 minutes on a syringe pump as well. The only commonly used antibiotic we run over an hour is gentamicin, which we dilute with 2mls of sterile water (regardless of dose) and run over 60 minutes.
  5. by   Gompers
    Every unit is going to have different ways of doing things, as we're seeing right here. It's best to call your hospital's pharmacy or pediatric unit to find out how they give the meds.

    We give ampicillin slow IV push over a few minutes, followed by 0.5-1cc normal saline slow IV push. We dilute it with sterile water to make it 100mg/ml regardless of baby's age/size/type of IV.

    Cefotaxime is diluted by the pharmacy for us - it used to be 100mg/ml but now they're doing it 40mg/ml. We give it on a syringe pump over 30 minutes.
  6. by   RainDreamer
    We always dilute our amp 100 to 1 with sterile water. And then give it IV push, followed by some NS to flush it through the tube.

    Cefotaxime comes up from pharmacy and we put that on the syringe pump ..... I don't remember how long because it's in the list of meds and it automatically sets the time, I think over 30 minutes or so.
  7. by   preemieRNkate
    We get 500mg powder vials of ampicillin from pharmacy, which we dilute with 5ml sterile water to make it 100mg/ml. We then give it over 5-10 minutes on a syringe pump. Cefotaxime comes from pharmacy already mixed and ready to give, and I believe we give it over 30 minutes. Alot of the antibiotics we give are over 30 minutes, anything that isn't usually says so on the label from pharmacy or we call them and ask. We also use the Neofax to determine how long to give it over.
  8. by   KRVRN
    Ampicillin 100mg/mL concentration... IVP over 3-5 min.

    Cefotaxime 100mg/mL concentration... IV over 30 min.
  9. by   BittyBabyGrower
    Our pharmacy makes them and we give both slow push.
  10. by   lovemyjob
    we give everything over 30 min except vancomycin which goes over 1 hr and ampho wich goes over 2hrs. there is another one that goes over 45 min....cant think of what it is. We use neofax to determine how fast to infuse. Gent def over 30 min. according to neofax, cefotaxime should go over the syringe pump for 30 min. Amp can be given over 3-5 min.

    Do all hospitals not use neofax as their standard/policy for med admin?
  11. by   luckylucyrn
    I don't know about neofax. We don't have a lot of neonates come through our ED, so I haven't been exposed to a lot of problems they might have. We get febrile neonates, high bilirubin babies, and a lot of first time parents that just need some guidance and reassurance. Most of the neonates go to our main children's hospital in memphis. My hospital has a limited Pediatric service. I'm learning what I can from each case because I would like to go to NICU someday.
  12. by   BittyBabyGrower
    Our pharmacy makes our med books up. They use several sources to come up with our guidelines, including neofax and the pediatric drug book.
  13. by   danissa
    Our most commom antib's are Benpen (3-5min push), Gentamicin (3-5 min push, Cefotaxime (3-5 min push) and Vanc over 1 hour. Also may use Fluclox as a push over 3-5 mins, we use benpen and gent as first line and prophylactic and the others for second line sepsis.
    Have never given Cef as an infusion, only as a push!
    Our pharmacy also makes up our antib's during the week, but we make them up for new admits or over the weekend.
  14. by   Pedi-ER-RN
    In our ER, we push both of them each over 3-5 min. Most of the docs do 50mg/kg/dose, so the dosages are the same. Our policy for gent is 30 min and Vanc is 1 hr.