Use of gravity infusions and bolus injections in adults during COVID-19

Published 26th March 2020, updated 24th June 2020

During the COVID-19 pandemic, use of gravity infusions and bolus injections for intravenous use may be more necessary than normal.

Gravity infusion sets may be used routinely in adults for:

Infusion fluids given alone such as sodium chloride 0.9% or glucose 5% with no added potassium
Infusion fluids with a medicine added where rate of administration does not need to be tightly controlled to prevent adverse effects

Medicines that can routinely be given via gravity infusion or intravenous bolus:

The table below lists medicines which may be added to infusions and given via gravity or which may be given by intravenous bolus injection.

Generally, if an IV medicine can be given safely by IV bolus injection, it should be administered as a bolus over a minimum of 3 minutes. All IV antibiotics should be given by IV bolus injection if it is safe to do so.

Click on individual links below to see corresponding information in Medusa injectable medicines guide.

Please also see the National Infusion and Vascular Access Society (NIVAS) Gravity infusion and Bolus IV drug administration guidance

Medicine	Gravity administration possible for intermittent infusions?	Bolus intravenous injection possible?	Notes
Amikacin	Yes	Yes
Amoxicillin	Yes	Yes
Ampicillin	Yes	Yes	Up to 500mg may be given by IV bolus injection.
Atenolol	Yes	Yes
Azathioprine	Yes	Yes
Azithromycin	Yes	No
Aztreonam	Yes	Yes
Benzylpenicillin	Yes	Yes	Up to 1.2g may be given by IV bolus injection over 3-5 minutes. For higher doses, the maximum rate of injection is 300mg/minute.
Betamethasone	Yes	Yes
Brivaracetam	Yes	Yes
Calcium folinate	Yes	Yes
Caspofungin	Yes	No
Cefepime	Yes	Yes
Cefotaxime	Yes	Yes
Ceftazidime	Yes	Yes
Ceftazidime with avibactam	Yes	No
Ceftobiprole	Yes	No
Ceftolozane with tazobactam	Yes	No
Ceftriaxone	Yes	Yes	Up to 2g may be given by IV bolus injection.
Cefuroxime	Yes	Yes
Chloramphenicol	Yes	Yes
Ciprofloxacin	Yes	No
Clarithromycin	Yes	No
Clindamycin	Yes	No
Colistimethate sodium (Colistin)	Yes	Specialist use. Central line
Co-amoxiclav	Yes	Yes
Co-fluampicil	Yes	Yes
Co-trimoxazole	Yes	No
Daptomycin	Yes	Yes	Manufacturer recommends IV infusion is preferable to IV injection.
Desmopressin	Yes	Yes	Check indication to determine method of administration.
Dexamethasone	Yes	Yes
Diclofenac 75mg/3mL (Voltarol)	Yes	No	Akis (diclofenac 75mg/mL) is not licensed for IV infusion.
Ertapenem	Yes	No
Erythromycin	Yes	No
Esomeprazole	Yes	Yes
Flucloxacillin	Yes	Yes	Up to 2g may be given by IV bolus injection. Give doses over 1g over 6 minutes.
Fluconazole	Yes	No
Flucytosine	Yes	No
Fosaprepitant	Yes	No
Furosemide	Yes	Yes	Maximum rate of administration 4mg/minute
Gentamicin	Yes	Yes
Hydrocortisone sodium PHOSPHATE	Yes	Yes
Hydrocortisone sodium succinate	Yes	Yes
Imipenem / cilastatin	Yes	No
Lacosamide	Yes	No
Lenograstim	Yes	No	Subcutaneous infusion used for most indications.
Levetiracetam	Yes	No
Linezolid	Yes	No
Meropenem	Yes	Yes
Meropenem with vaborbactam	Yes	No
Methylprednisolone sodium succinate	Yes	Yes	Up to 250mg may be given by IV bolus injection.
Metronidazole	Yes	No
Omeprazole	Yes	No
Ondansetron	Yes	Yes	Do not give IV bolus injection to elderly for chemo- or radio-therapy induced nausea/vomiting.
Pantoprazole	Yes	Yes
Paracetamol	Yes	No
Phytomenadione	Yes	Yes
Piperacillin/tazobactam	Yes	No	May be given by IV bolus injection (unlicensed) in some circumstances.
Ranitidine	Yes	Yes
Rifampicin	Yes	No
Tedizolid	Yes	No
Teicoplanin	Yes	Yes
Temocillin	Yes	Yes
Ticarcillin with clavulanic acid	Yes	No
Tigecycline	Yes	No
Tobramycin	Yes	Yes
Tramadol	Yes	Yes
Vitamin B with ascorbic acid (Pabrinex IV High Potency)	Yes	No
Zanamivir	Yes	No
Zidovudine	Yes	No