Clinical StudiesAdverse effects of outpatient parenteral antibiotic therapy
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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