Outpatient parenteral antimicrobial therapy: experience in a large teaching hospital.

OBJECTIVE

to determine the practicality of treatment of infectious conditions requiring prolonged parenteral antimicrobial therapy.

METHOD: review of all patients admitted to a Regional Infectious Diseases (ID) Unit who received outpatient parenteral therapy over a 12-month period. The study identified the conditions suitable for outpatient therapy, the organization of treatment and the complications and financial implications of the service.

RESULTS

fifteen patients (age range 32-81) received outpatient parenteral antimicrobial therapy during the period of the study. Five patients were HIV-positive and were treated for cytomegalovirus retinitis or severe recurrent candida infection with self-administration of drugs through a Hickman line. HIV-negative patients were treated for osteomyelitis, deep-seated abscesses and subacute bacterial endocarditis. Eight of the 10 HIV-negative patients were given ceftriaxone once daily. The organization and delivery of outpatient drug therapy depended on the nature of the underlying infection and the availability of community services. Outpatient therapy was associated with considerable financial savings, and no serious adverse events were recorded.

CONCLUSION

outpatient parenteral treatment is a reasonable option for a relatively small number of patients, representing less than 2% of patients admitted to the ID Unit over the time course of the study. Patients suitable for outpatient treatment have a stable medical condition and require prolonged antimicrobial therapy.