Practice guidelines for community-based parenteral anti-infective therapy

Antibioterapia intravenosa en domicilio. Estudio de 515 casos

OBJECTIVE

To assess the effectiveness of therapy, type of infection, hospital department of origin and outcome of 515 cases of infection requiring home intravenous antibiotic therapy treated by the home care service.

METHODS

The clinical records of patients undergoing intravenous antibiotic therapy through the home care service over a 6-year period were retrospectively reviewed.

RESULTS

A total of 439 patients (244M/195F; mean age, 55.9 years, range 7-96) requiring 515 courses of home intravenous antibiotic therapy were reviewed. Mean duration of antibiotic therapy was 7.9 days (1-58). Urinary (42.3%) and respiratory infections (25.8%) were the most frequent indications for home treatment. Most patients were referred from the emergency room (50.5%) followed by the Internal Medicine Department (11.5%) and Oncology Department (11.1%). Ceftriaxone was the most widely prescribed antibiotic (41.8%) followed by aminoglycosides (35.3%) and glycopeptides (11.7%). In 49 cases electronic infusion pumps were used, with ceftazidime being the predominant antibiotic (32.7%) in these cases. Hospitalization was required in 7% of patients due to infectious disease-related complications. Clinical outcome was positive in 79% of the patients, with improvement in 90% of patients from the emergency room

CONCLUSIONS

The advantages of home care services to provide home intravenous antibiotic therapy are evident. More than half of the patients were referred from the emergency room and 90% of these progressed well. The presence of medical and nursing staff qualified to handle infectious diseases is necessary, as well as continuing home care.

Ambulatory use of parenteral antibacterials: contemporary perspectives

Outpatient parenteral antimicrobial therapy (OPAT) offers increased patient comfort and convenience in appropriately selected patients who require parenteral antibacterial therapy, as well as opportunity for cost savings. Home-based programmes, with drugs being administered by the patient or the caregiver, have become the norm in the USA. Choice of drugs for OPAT is based on antimicrobial spectrum, dosage regimen, drug stability, toxicity profile, and cost. Over the past decade, availability of sophisticated programmable pumps has allowed a wider range of antimicrobial agents to be used in the ambulatory setting. The most popular antibacterial agents in OPAT programmes in the USA are vancomycin and beta-lactams.