[Favorable results with intravenous antimicrobial therapy outside the hospital]. / Gunstige ervaringen met intraveneuze antimicrobiële therapie buiten het ziekenhuis.

OBJECTIVE: To determine whether intravenous home treatment with antimicrobial drugs of patients with an infection is feasible. DESIGN: Descriptive. SETTING: Academic Hospital, Leiden, the Netherlands. METHODS: In October 1992 a programme for intravenous home treatment of patients with infectious diseases was started. The programme was based on self-administration of the intravenous antibiotic therapy by the patient. The hospital pharmacy provided the antibiotics and infusion devices, an infectious diseases specialist supervised the home treatment and the nursing staff of the First Aid Department was available to change infusion cannulas. After assessment of their medical and psychosocial fitness in which the general practitioner was involved, thorough instruction on use of the infusion device and care of the infusion cannula, patients were sent home. RESULTS: In the period October 1992-September 1996, 162 patients (median age: 45.0 years (range: 3-82)) were treated at home for a median period of 15 days (1-221). Osteomyelitis, arthritis, Lyme disease, septicaemia with secondary foci, and herpes virus infections were the most frequent indications for home treatment. Penicillins and cephalosporins were given in 70% of the cases, teicoplanin and antiviral drugs in 12% and 14%, respectively. For intermittent administration bolus injection, a mechanical or elastomeric pump were used, for continuous infusion a syringe or cassette pump. The intention of the programme that the patient performed the home treatment as much as possible without extra professional help, was realised in 82% of the patients. In 60% of the cases the patients were fully self supporting, in 22% family or friends played an important role. CONCLUSION: Home treatment with antimicrobial drugs intravenously is quite feasible. If this were fully implemented, about 1400 patients in the Netherlands could be treated in this manner.

[Impediments to incubator home care in The Netherlands]. / Belemmeringen voor couveuse-thuiszorg in Nederland.

OBJECTIVE: To determine whether incubator home care is desirable and feasible. DESIGN: Inventory. SETTING: Four neonatal units representative of the type of care in general hospitals in the Netherlands. METHOD: The relevant data on all infants with a birth weight < or = 2000 g admitted in the last 3 months of 1996 to one of four hospitals were analysed. Conditions for incubator home care were determined (e.g. absence of need for special care, vital function monitoring or nasogastric tube feeding). RESULTS: Forty-nine infants were enrolled. Mean hospital stay was 28.7 days in an incubator plus 19.7 days in a cot. When infants were placed in a cot they usually still needed tube feeding and monitoring of vital functions and sometimes parenteral nutrition, medication or extra oxygen which made home discharge impossible. Therefore a pilot study of actual home care could not be carried out. CONCLUSION: Although early home discharge is very desirable for newborn infants, the number of infants eligible for incubator home care is so small that further attempts to organise it are not useful.