Clinical Studies
Adverse effects of outpatient parenteral antibiotic therapy

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Abstract

PURPOSE: Although home parenteral antimicrobial therapy has become common, few studies have carefully examined its adverse effects.

SUBJECTS AND METHODS: We retrospectively reviewed the medical records of 269 patients who received 291 courses of home parenteral antimicrobial therapy through a hospital-based home infusion program during a 2-year period. Patients with human immunodeficiency virus (HIV) infection were not included.

RESULTS: The majority (59%) of patients were treated for bone and joint infections. Patients had a mean age of 47 years. The mean duration of antibiotic therapy was 40 days. Of monitored courses, leukopenia occurred in 16%, neutropenia in 7%, thrombocytopenia in 4%, and eosinophilia in 12%, usually after a month of therapy; these adverse effects were most frequently associated with the use of beta-lactam antibiotics. Nephrotoxicity occurred in 8% of monitored courses at a mean of 27 days and was most commonly associated with amphotericin B. Diarrhea occurred in 7% and rash in 4% of patients, and both were most commonly seen with beta-lactam antibiotics. Of those patients with permanent indwelling catheters, 11% of those with central catheters and 9% of those with peripherally inserted central catheters (PICCs) developed line complications. Overall, 8% of patients required rehospitalization.

CONCLUSION: Home infusion antibiotic therapy exposes patients to the complications associated with inpatient antibiotic therapy and needs to be monitored closely to prevent serious complications and rehospitalizations.

Section snippets

Methods

We reviewed the charts of all patients receiving home outpatient parenteral antibiotic therapy between January 1992 and December 1993 at the Jefferson Hospital Home Infusion Program based at an inner-city 700-bed tertiary care university teaching hospital. Patients with known human immunodeficiency virus (HIV) infection were excluded from the study group because of the difficulty involved in interpreting hematologic, renal, and gastrointestinal side effects in these patients. All attending

Results

A total of 269 patients received 291 courses of antibiotics during the study period. Bone and joint infections were the most commonly treated diagnoses (59%), followed by endovascular infections (16%) and abscesses (9%). Patients with Lyme disease, cellulitis, pneumonia, sinusitis, urinary tract infections, meningitis, ocular infections, and neurosyphilis were also treated. Men received 167 (57%) of the antibiotic courses. The ages of the patients ranged from newborn to 86 years, with a mean of

Discussion

Our study provides a comprehensive review of complications incurred by patients, except those with HIV infection, who received home parenteral antibiotic therapy over a 2-year time period. As a retrospective chart review, we did not ascertain patients’ insurance status, duration of line placement, and the incidence of sterile phlebitis. Patients were followed by different physicians and associations of visiting nurses, who had different line care and anticoagulation policies and practices.

Conclusion

Our review of patients who receive home infusion antibiotics emphasizes the need for close follow-up of hematologic and renal parameters as well as gastrointestinal, allergic, and access-related problems. Home infusion antibiotics have the same toxicities as in-hospital antibiotics. Rehospitalization for treatment-related side effects occurred more frequently than in previous studies. Close monitoring is needed throughout therapy, as many complications occurred late in the course of treatment.

Acknowledgements

Special thanks to Lynn Nagel for secretarial assistance and Thomas Wasser, MEd, PhD, for statistical assistance.

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