Practice guidelines for community-based parenteral anti-infective therapy. ISDA Practice Guidelines Committee.

This is the fourth in a series of practice guidelines commissioned by the Infectious Diseases Society of America through its Practice Guidelines Committee. The purpose of this guideline is to provide assistance to clinicians when making decisions on when and how to best administer parenteral antimicrobial therapy. The targeted providers are internists, pediatricians, family practitioners, and other providers of outpatient antiinfective therapy. Criteria for selecting the appropriate patients and settings to deliver therapy in the community are described. Panel members represented experts in adult and pediatric infectious diseases. The guidelines are evidence-based. A standard ranking system is used for the strength of the recommendations and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council. An executive summary and tables highlight the major recommendations.

Antibiotic treatment of pharyngitis.

Pharyngitis is one of the most common medical problems and ranges in severity from minor to fatal. The treatment regimens presented have been standardized for the various pathogens on the basis of clinical response and pathogen eradication. The current major challenge is the rapid recognition and diagnosis of streptococcal infection and clarification of the etiologic role of several nonstreptococcal pathogens.

Outpatient intravenous antibiotic therapy. Ten years' experience.

The experience within the past ten years at Methodist Hospital and Park Nicollet Medical Center, Minneapolis, has clearly demonstrated that outpatient intravenous (IV) antibiotic therapy can be undertaken with relative ease and results in substantial cost savings. During this time, no significant morbidity and no mortality associated with this modality have occurred. Patients of all ages with bone, joint, skin, or soft-tissue infection and other infectious diseases such as meningitis have participated. Patient compliance and enthusiasm have been high. Necessary elements for such a program include an enthusiastic medical staff, a central admixture service, and a team of nurses or other health care professionals available for IV cannula care. Careful patient selection, education, and follow-up are also essential. We believe use of outpatient IV antibiotic therapy will continue to grow in the future, in part because of changes in the financing of medical care.

Bone and serum concentrations of five cephalosporin drugs. Relevance to prophylaxis and treatment in orthopedic surgery.

Bone and serum concentrations of five cephalosporins were assayed in 92 patients undergoing elective hip or knee prosthetic joint arthroplasty. One hundred twenty-five bone samples were assayed. Although there was no direct relation between serum and bone antibiotic concentrations, a trend toward increased bone antibiotic concentration for drugs with higher serum levels and longer half-lifes (cefazolin and ceforanide) was noted. Bone antibiotic concentrations were maximal within 60 minutes of drug administration. Although bone antibiotic concentrations following 2-g doses were greater than those following 1-g doses, the differences were not statistically significant. A trend toward higher bone antibiotic concentrations at hip surgery was noted, and this difference achieved statistical significance (p less than 0.05) for cefazolin. As a result of analysis of bone antibiotic concentrations, antimicrobial sensitivities, and cost, administration of 2 g of cefazolin immediately prior to operation, followed by 1 g every eight hours for 24 hours, is recommended in elective prosthetic joint surgery.

Prophylactic antibiotics in hip fractures. A double-blind, prospective study.

Three hundred and seven patients, each of whom had a fracture of the proximal part of the femur, were studied in a randomized, double-blind fashion to determine whether perioperative administration of cephalothin would prevent postoperative infection. Major postoperative wound infections were significantly reduced in the cephalothin-treated group (4.7 per cent versus 0.7 per cent; p less than 0.05). There also was a reduction in the incidence of postoperative urinary-tract infections and a reduction in mean peak body temperatures. The duration of hospitalization was not affected and no hospital stay was prolonged by complications of antibiotic administration. However, in the cephalothin-treated group, a strong trend toward colonization by cephalothin-resistant organisms was noted.

Intravenous antibiotic therapy at home.

Many patients who are hospitalized for intensive intravenous (IV) antibiotic therapy of serious infections are not disabled. Following a short period of treatment in the hospital and after their medical problem has stabilized, these patients can safety receive IV antibiotics at home. Patients who had osteomyelitis or infective endocarditis were selected for this study. Utilizing an IV nurse team, patients were instructed in the administration of the antibiotic. They returned to the hospital every 48 hours to have their IV catheter changed and to receive a new supply of antibiotic. There was a substantial monetary saving with each treatment course (at least $1,600 per patient), and, in addition, the patients were much more comfortable at home and some returned to work or to school.