Monitoring Guidelines for Home and Outpatient Parenteral Antibiotic Therapy

When prescribing home intravenous antibiotic therapy (HIVAT), physicians must consider not only the factors normally considered in a hospital setting, but also the limitations and advantages of home therapy. Examples include dosage schedule, short and long term toxicity, stability of the antibiotics...

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Main Author: Alain Y Martel
Format: Article
Language:English
Published: Wiley 2000-01-01
Series:Canadian Journal of Infectious Diseases
Online Access:http://dx.doi.org/10.1155/2000/890647
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author Alain Y Martel
author_facet Alain Y Martel
author_sort Alain Y Martel
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description When prescribing home intravenous antibiotic therapy (HIVAT), physicians must consider not only the factors normally considered in a hospital setting, but also the limitations and advantages of home therapy. Examples include dosage schedule, short and long term toxicity, stability of the antibiotics at room temperature after dilution, half-life of antibiotics, compatibility with other antibiotics or medications in the same bag and distribution methods from the supplier (pharmacy) to the patient. Consideration of these factors may direct antimicrobial choices, the mode of delivery and treatment schedule. Other prerequisites for antibiotic selection for home therapy include tolerability and low incidence of toxic reactions. Physicians and nurses must be aware of the adverse effects associated with prolonged outpatient intravenous antimicrobial therapy. Additional knowledge must include pharmacokinetics (absorption, distribution and elimination) and the pharmacodynamics (biochemical and physiological effects and mechanisms of action) of the commonly used antibiotics. One simple guideline is the less often a drug has to be administered, the more convenient the therapy will be for the patients, facilitating a higher rate of compliance. The less frequent administration schedules will also require less staff time for training and troubleshooting. Many antimicrobial agents can be given once daily and, therefore, readily meet this objective. Classes of antimicrobials that can be used once daily include aminoglycosides, ceftriaxone, vancomycin and the new quinolones. The development of antimicrobials that can be administered less often has been a major factor contributing to the growth of HIVAT. If an antibiotic has to be used more frequently than three times a day, the use of a computerized ambulatory infusion pump is helpful; however, pumps are expensive and not readily available. Other considerations for HIVAT include renal impairment, liver failure and hematological toxicities. These factors have led the author and colleagues to develop specific monitoring recommendations and techniques.
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spelling doaj-art-b2c1bbda2dab46a69a5665f65bb7436d2025-02-03T05:51:36ZengWileyCanadian Journal of Infectious Diseases1180-23322000-01-0111Suppl A35A44A10.1155/2000/890647Monitoring Guidelines for Home and Outpatient Parenteral Antibiotic TherapyAlain Y Martel0Microbiologiste-Infectiologue, Interniste, Professeur Agrége de Clinique, CHUC Centre Hospitalier de l’Université Laval, Laboratoire de Microbiologie, Service d’Infectiologie, Sainte-Foy, Québec, CanadaWhen prescribing home intravenous antibiotic therapy (HIVAT), physicians must consider not only the factors normally considered in a hospital setting, but also the limitations and advantages of home therapy. Examples include dosage schedule, short and long term toxicity, stability of the antibiotics at room temperature after dilution, half-life of antibiotics, compatibility with other antibiotics or medications in the same bag and distribution methods from the supplier (pharmacy) to the patient. Consideration of these factors may direct antimicrobial choices, the mode of delivery and treatment schedule. Other prerequisites for antibiotic selection for home therapy include tolerability and low incidence of toxic reactions. Physicians and nurses must be aware of the adverse effects associated with prolonged outpatient intravenous antimicrobial therapy. Additional knowledge must include pharmacokinetics (absorption, distribution and elimination) and the pharmacodynamics (biochemical and physiological effects and mechanisms of action) of the commonly used antibiotics. One simple guideline is the less often a drug has to be administered, the more convenient the therapy will be for the patients, facilitating a higher rate of compliance. The less frequent administration schedules will also require less staff time for training and troubleshooting. Many antimicrobial agents can be given once daily and, therefore, readily meet this objective. Classes of antimicrobials that can be used once daily include aminoglycosides, ceftriaxone, vancomycin and the new quinolones. The development of antimicrobials that can be administered less often has been a major factor contributing to the growth of HIVAT. If an antibiotic has to be used more frequently than three times a day, the use of a computerized ambulatory infusion pump is helpful; however, pumps are expensive and not readily available. Other considerations for HIVAT include renal impairment, liver failure and hematological toxicities. These factors have led the author and colleagues to develop specific monitoring recommendations and techniques.http://dx.doi.org/10.1155/2000/890647
spellingShingle Alain Y Martel
Monitoring Guidelines for Home and Outpatient Parenteral Antibiotic Therapy
Canadian Journal of Infectious Diseases
title Monitoring Guidelines for Home and Outpatient Parenteral Antibiotic Therapy
title_full Monitoring Guidelines for Home and Outpatient Parenteral Antibiotic Therapy
title_fullStr Monitoring Guidelines for Home and Outpatient Parenteral Antibiotic Therapy
title_full_unstemmed Monitoring Guidelines for Home and Outpatient Parenteral Antibiotic Therapy
title_short Monitoring Guidelines for Home and Outpatient Parenteral Antibiotic Therapy
title_sort monitoring guidelines for home and outpatient parenteral antibiotic therapy
url http://dx.doi.org/10.1155/2000/890647
work_keys_str_mv AT alainymartel monitoringguidelinesforhomeandoutpatientparenteralantibiotictherapy