Adverse effects of outpatient parenteral antibiotic therapy

• Published in: The American journal of medicine Vol. 106; no. 1; pp. 44 - 49
• Main Authors: Hoffman-Terry, MargaretL, Fraimow, HenryS, Fox, TimothyR, Swift, BrianG, Wolf, JudithE
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 1999; Elsevier; Elsevier Sequoia S.A
• Subjects: Adult; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Catheters, Indwelling - adverse effects; Drug Hypersensitivity - etiology; Drug therapy; Female; Gastrointestinal Diseases - chemically induced; General aspects; Hematologic Diseases - chemically induced; Home health care; Home Infusion Therapy - adverse effects; Home Infusion Therapy - instrumentation; Humans; Infusions, Intravenous - adverse effects; Male; Medical Records; Medical sciences; Middle Aged; Patient Readmission; Patients; Pharmacology. Drug treatments; Renal Insufficiency - chemically induced; Retrospective Studies; United States; North America; America; Human; Intravenous administration; Toxicity; Exploration; Hospitalization; Epidemiology; Morbidity; Infection; Antibiotic; Chemotherapy; Treatment; Ambulatory; Public health
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/S0002-9343(98)00362-3

PURPOSE: Although home parenteral antimicrobial therapy has become common, few studies have carefully examined its adverse effects. SUBJECTS AND METHODS: We retrospectively reviewed the medical records of 269 patients who received 291 courses of home parenteral antimicrobial therapy through a hospital-based home infusion program during a 2-year period. Patients with human immunodeficiency virus (HIV) infection were not included. RESULTS: The majority (59%) of patients were treated for bone and joint infections. Patients had a mean age of 47 years. The mean duration of antibiotic therapy was 40 days. Of monitored courses, leukopenia occurred in 16%, neutropenia in 7%, thrombocytopenia in 4%, and eosinophilia in 12%, usually after a month of therapy; these adverse effects were most frequently associated with the use of beta-lactam antibiotics. Nephrotoxicity occurred in 8% of monitored courses at a mean of 27 days and was most commonly associated with amphotericin B. Diarrhea occurred in 7% and rash in 4% of patients, and both were most commonly seen with beta-lactam antibiotics. Of those patients with permanent indwelling catheters, 11% of those with central catheters and 9% of those with peripherally inserted central catheters (PICCs) developed line complications. Overall, 8% of patients required rehospitalization. CONCLUSION: Home infusion antibiotic therapy exposes patients to the complications associated with inpatient antibiotic therapy and needs to be monitored closely to prevent serious complications and rehospitalizations.