Home intravenous antibiotics in a tertiary care hospital in Saudi Arabia

Abstract

BACKGROUND AND OBJECTIVE:Home intravenous (IV) antibiotic programs are becoming increasingly popular worldwide because of their efficacy and safety. However, in Saudi Arabia these programs have not yet become an integrated part of the health care system. We present our experience with a home IV antibiotic program, as one of the major health care providers in Saudi Arabia.DESIGN AND SETTING:Retrospective chart review of patients enrolled in the King Abdulaziz Medical City Home Health Care IV Antibiotic Program from 1 May 2005 (the start of the program) until 30 December 2007.METHODS:In addition to demographic characteristics, we collected data on the site of infection, the clinical diagnosis, the isolated microorganisms, and the type of antibiotics given. Outcome measures evaluated included the relapse rate, failure rate, the safety of the program, and readmission rates.RESULTS:Of the 155 patients enrolled, 152 patients completed the program. Those who completed the program had a mean (SD) age of 52.8 (23.9) years. The mean (SD) duration of the IV antibiotic treatment was 20.6 (17) days. Three patients refused to complete the intended duration of therapy. Peripherally inserted central catheter (PICC) lines were utilized in 130 patients (86%). One-hundred and thirty-one patients completed the intended duration of therapy, although the therapy was changed from the initial plan for 21 (13.8%) patients. Readmission to the hospital during therapy was required for 13 patients (8.5%). Osteomyelitis was the most frequently encountered diagnosis (65 patients, 42.8%), followed by urinary tract infection (36 patients, 23.7%).CONCLUSIONS:The home health care-based IV antibiotic program was an effective and safe alternative for in-patient management of patients with non-life-threatening infections, and was associated with a very low complication rate. Home IV antibiotic programs should be used more frequently as part of the health care system in Saudi Arabia.

Safety and effectiveness of ‘hospital in the home’ and ‘outpatient parenteral antimicrobial therapy’ in different age groups: A systematic review of observational studies

“…Twenty‐six studies published between 1997 and 2016 analysed the safety and effectiveness of OPAT services. This included 3 prospective studies without comparison group and 23 retrospective studies without comparison group . Nine studies were performed in Europe, eight in the USA, two in Australia, two in New Zealand, two in Singapore, one in Canada, one in Saudi Arabia and one in Israel .…”

“…Most of the OPAT studies reported a cure or treatment success rate of greater than 80%, 12,18,21,33,37,[41][42][43]45,[52][53][54][55]66 readmission rate ranged from 1% 38 to 14.3%, 36 mortality rate varied from 0% 55 to 1.4%, 28 VAD related complications ranged from 0% 44 to 25% 38 and adverse drug reactions rate varied from 0.3% 43 to 30.2%. 37 A few studies reported more complications and adverse events 28,33,37,53,58 compared with the other studies and recommended that close monitoring is needed in OPAT service 28 and that OPAT programs should be tailored for each disease.…”

“…Numerous studies assessing the adverse events (AEs) and effectiveness of HITH and OPAT have been performed in many countries including Australia, USA, UK, Spain, France, Singapore, Israel, Canada, Italy, Ireland, New Zealand, Saudi Arabia, Switzerland and Greece . Some studies have analysed the safety of HITH or OPAT for a particular disease or for a particular group including geriatric or paediatric patients …”

“…Numerous studies assessing the adverse events (AEs) and effectiveness of HITH and OPAT have been performed in many countries including Australia, 2,9,[19][20][21][22][23][24][25][26] USA, [27][28][29][30][31][32][33][34][35][36][37][38][39][40] UK, 4,[41][42][43][44][45] Spain, 3,8,11,15,46 France, 47,48 Singapore, 12,49 Israel, 50 Canada, 51 Italy, 17 Ireland, 52 New Zealand, 53 Saudi Arabia, 54 Switzerland 55 and Greece. 56 Some studies have analysed the safety of HITH or OPAT for a particular disease or for a particular group including geriatric 11,15,17,…”

“…Twenty-six studies published between 1997 and 2016 analysed the safety and effectiveness of OPAT services.This included 3 prospective studies without comparison group12,42,58 and 23 retrospective studies without comparison group 4,18,21,28,29,33,[35][36][37][38][39]41,[43][44][45][49][50][51][52][53][54][55]66. Nine studies were performed in Europe,4,18,[41][42][43][44][45]52,55 eight in the USA,28,29,33,[35][36][37][38][39] two in Australia,21,66 two in New Zealand,53,58 two in Singapore,12,49 one in Canada,…”