Evolution of outpatient parenteral antibiotic therapy.

The future will no doubt continue to promote safe, cost-effective therapies such as outpatient intravenous therapy. It is imperative that physicians trained and knowledgeable in the administration of outpatient intravenous antimicrobial drug administration continue to assume responsibility and leadership roles.

Outpatient parenteral antibiotic therapy.

Clinical studies have shown that outpatient administration of parenteral antibiotics is sage, cost-effective and practical. The development of new antibiotics with prolonged half-lives, such as ceftriaxone or cefotetan, has facilitated outpatient parenteral antibiotic therapy (OPAT). Good OPAT management requires coordination of physicians, nurses, pharmacists and health care administrators, and the establishment of firm guidelines. A variety of infections can be treated through OPAT, including osteomyelitis and soft tissue infections, chronic urinary tract infections, and ear, nose and throat infections.

Treatment of skin and soft-tissue infections utilizing an outpatient parenteral drug delivery device: a multicenter trial. HIAT Study Group.

The purpose of this study was to examine the safety and efficacy of outpatient intravenous antibiotic therapy for skin and soft-tissue infections and determine its effect on length of hospital stay. In this open-label, multicenter, prospective study, 130 adult patients with skin and soft-tissue infections requiring parenteral antibiotic therapy were enrolled as a subgroup. Initial therapy was delivered to hospital inpatients or in outpatient treatment centers, followed by home infusion therapy. Cefotaxime was delivered intravenously using a programmable ambulatory infusion pump. The clinical response rate was 97.5% (n = 118), while the bacteriologic response rate was 94.0% (n = 83). Only 32.2% of patients required hospitalization, and the mean duration of inpatient care for all evaluable patients was only 1.5 days. The mean duration of hospitalization for patients receiving inpatient care was 4.7 days. In conclusion, home intravenous cefotaxime therapy is safe, effective, and may reduce healthcare costs for many patients with skin and soft-tissue infections.

Treatment of serious infections with cefotaxime utilizing an outpatient drug delivery device: global analysis of a large-scale, multicenter trial. HIAT Study Group.

The primary objective of this multicenter, prospective trial was to determine the safety, efficacy, and cost effectiveness of cefotaxime delivered via an ambulatory delivery system (ADS) in the treatment of patients with a variety of bacterial infections. The secondary objective was to determine the safety and efficacy of cefotaxime/ADS treatment of infections in a diabetic subgroup. A total of 238 patients (> or = 18 years) in five infection categories were enrolled from 10 sites. All patients received cefotaxime/ADS. Both global analysis and analysis of a subpopulation with diabetes mellitus were performed. Of the 211 patients who completed the study, 201 patients (95.3%) exhibited a satisfactory or improved clinical response following cefotaxime/ADS. Bacteriologic response, evaluable in 134 of 211 patients, was satisfactory in 125 of these patients (93.3%). Within the diabetes mellitus subpopulation, a satisfactory or improved clinical response was identified in 30 of 32 patients (93.8%). In conclusion, administration of cefotaxime via ADS is a well-tolerated, safe, and clinically effective treatment of serious infection and may be less expensive than inpatient intravenous antibiotic therapy.

Outpatient parenteral antibiotic therapy. Management of serious infections. Part II: Amenable infections and models for delivery. Infusion center, office, and home.

Outpatient parenteral antibiotic therapy (OPAT) administered in an infusion center often offers the advantages but not the expense of the hospital setting. Office-based OPAT maintains the physician-patient relationship but may be impractical for the physician. Home administration is ideal for selected patients, but when it is provided by an infusion company, the physician may be sidestepped.

Home intravenous antibiotic therapy.

This article examines the development of a home intravenous program, types of outpatient intravenous programs, the criteria for patient selection, the equipment required, types of infections treated, the use of antimicrobics, clinical experience in the elderly, and financial considerations.

The infusion center: a model for outpatient parenteral antibiotic therapy.

Outpatient parenteral treatment of infectious diseases has developed from primitive beginnings to its present state as the standard of care in many areas. The large infusion center described here is headed by physicians who specialize in infectious diseases and occupies a free-standing building where the pharmacy, laboratory, physicians' offices, examination rooms, and finance departments are centralized for efficiency, flexibility, and convenience. Each patient is seen by a physician, pharmacist, and nurse; these health care professionals share data about the patient and offer 24-hour coverage of questions and emergencies. Treating a wide variety of diseases, physicians utilize their experience and the center's intercommunication system to choose drugs most suitable for outpatient use and to carry on research. Costs in the center run between 50% and 60% lower than those in the hospital. Reimbursement, although difficult in the past, has improved considerably, but some third-party payers, including Medicare, have not reimbursed for outpatient intravenous antibiotic therapy.

Antibiotic therapy of osteomyelitis in outpatients.

The therapy of osteomyelitis utilizing 481 courses of intravenous antibiotics in outpatients was analyzed to identify the types of bone infection most frequently treated by this form of therapy. The efficacy of this form of treatment is also discussed.

Ciprofloxacin therapy of infections caused by Pseudomonas aeruginosa and other resistant bacteria.

Ciprofloxacin was administered orally to 48 patients with 24 Pseudomonas aeruginosa infections and 13 other infections caused by cephalothin-resistant gram-negative bacilli. The types of infections treated included those of skin or skin structure, bone, urinary tract, and respiratory tract. In 83% of P. aeruginosa infections, a favorable clinical outcome occurred, compared with 85% for all infections. Failure to achieve a cure correlated with the emergence of resistant P. aeruginosa and Acinetobacter calcoaceticus strains in four instances and superinfection with Candida (two cases) and Streptococcus (two cases) species. Therapy was discontinued in three patients because of the development of nausea. Ciprofloxacin appears to be safe and effective in the therapy of infections caused by resistant gram-negative bacilli.

Intravenous antibiotic therapy in ambulatory pediatric patients.

Eighty-nine pediatric patients (median age, 12.0; range, 1.5 to 18 years) were treated with antibiotics given intravenously by self- or parent administration for a variety of infections, under close physician supervision. Patients with infections involving bone and joint (53), respiratory tract (16), soft tissue (9), abdominal cavity (4), genitourinary tract (4) and bloodstream (3) were treated for a mean period of 19.0 days. Staphylococcus aureus, Pseudomonas aeruginosa and Haemophilus influenzae were the most frequent pathogens. Favorable clinical outcomes occurred in 85 patients (96%). Adverse clinical and laboratory events occurred at a frequency commensurate with that of hospitalized patients. A total of 1700 patient days were managed in this outpatient setting at significant cost savings, and the method allowed early return to school for 83 patients (93%). Intravenous antibiotic therapy in ambulatory patients can provide a successful, safe, cost-effective alternative to inpatient care under conditions of diligent patient screening and physician-centered follow-up.

Combined ceftriaxone and surgical therapy for osteomyelitis in hospital and outpatient settings.

The combined medical-surgical approach to therapy for osteomyelitis requires patients to receive intravenous antibiotics three to six times daily for 4 to 6 weeks after initial surgical debridement. The greatly extended half-life of the new cephalosporin, ceftriaxone (6 to 8 hours), enabled its intravenous administration once or twice daily to 76 patients for the treatment of osteomyelitis. Cure or improvement was noted in 66 of the 76 patients (87 percent). Most of the failures occurred in the group of patients with osteomyelitis complicated by vascular insufficiency. The once or twice daily dosing possible with ceftriaxone was particularly advantageous for permitting highly cost-effective at home therapy for 42 of the 76 patients.