Parenteral antibiotics at home

Looke, David; McDougall, David

doi:10.18773/austprescr.2012.086

Cited by 6 publications

(12 citation statements)

References 3 publications

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“…The proportion of patients with unplanned nursing visits and readmission to hospital were also in keeping with the Australian and international literature. 3,4,9,[19][20][21][22] Appropriate patient selection is fundamental in minimising treatment complications in the home setting 8 and optimising the efficiency of the HITH service. We were unable to identify patient characteristics associated with AEs, although a previous Australian study Days under HITH care identified that administration of antibiotic therapy to HITH patients with a previous reaction to a medicine in the same class and repeat treatment courses, are associated with adverse drug reactions in the home setting.…”

Section: Discussionmentioning

confidence: 99%

“…There is less direct patient supervision than inpatient care, for example, and face‐to‐face contact between patients and nursing providers is generally limited to once per day in order to maximise the efficiency of the HITH service. Treatment options are limited to antibiotics mainly suitable for once daily administration or those with sufficient stability data to support administration as a continuous infusion . Infusions are delivered via an elastomeric infuser or ambulatory electronic pump and IV access, using a vascular access device (VAD) such as a midline or peripherally inserted central catheter (PICC) for extended treatment.…”

Section: Introductionmentioning

confidence: 99%

“…Treatment options are limited to antibiotics mainly suitable for once daily administration or those with sufficient stability data to support administration as a continuous infusion. 8 Infusions are delivered via an elastomeric infuser or ambulatory electronic pump and IV access, using a vascular access device (VAD) such as a midline or peripherally inserted central catheter (PICC) for extended treatment. Evidence suggests that parenteral antibiotic treatment in the HITH setting is not without harm, with at least 25% of all patients experiencing adverse events (AE).…”

Section: Introductionmentioning

confidence: 99%

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Safety of continuous antibiotic infusions administered through an Australian hospital in the home service: a pilot study

Pandya

Eaton

Kowalski

et al. 2017

Pharmacy Practice and Res

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Background Few studies have assessed the safety of antibiotic infusions in the hospital in the home (HITH) setting, or the vascular access and ambulatory infusion devices used for delivering these infusions. Aim To explore treatments and health outcomes for HITH patients administered continuous antibiotic infusions through an ambulatory infusion device. Method Case notes for patients managed by a HITH service affiliated with a large metropolitan hospital were retrospectively audited. Consecutive patients treated for cellulitis, osteomyelitis, endocarditis, diabetic foot infection or septic arthritis between January and September 2014, and receiving intravenous antibiotic therapy through an ambulatory infusion device, were included. Patients were followed until discharge from HITH to determine adverse outcomes related to antibiotic therapy, including administration devices. Results The audit recruited 31 patients with a median age of 62 years; 17 (55%) were male. Overall 14 adverse events were experienced by 10 (32%) patients. Of the 14 adverse events, nine (64%) were medication‐related, one (7%) related to a vascular access device and four (29%) were infusion device‐related. Therapeutic failure occurred in four patients; three were re‐hospitalised; and one had their therapy extended. Most patients had an infusion that was identified as not running to completion on at least one occasion at the time of their home visit (81%), or problems with flushing lines or aspirating blood from the vascular access devices (35%). Conclusion Adverse events were commonly observed among patients receiving continuous antibiotic infusions in this pilot study. Further research is needed to identify patients at risk of adverse events.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Safety of continuous antibiotic infusions administered through an Australian hospital in the home service: a pilot study

Pandya

Eaton

Kowalski

et al. 2017

Pharmacy Practice and Res

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“…OPAT patients can receive highly concentrated intravenous antibiotics via portable infusion pumps over repeated 24 hours infusions after discharge from hospital. Medication stability is a critical factor when deciding if these antibiotics are appropriate for use as extended infusions 1. Poor drug stability may result in the patient receiving less than the intended dose required to treat the infection2–6 leading to extended treatment durations, treatment failure, readmissions to hospital and antibiotic resistance 7.…”

Section: Introductionmentioning

confidence: 99%

“…Most stability data include these parameters up to room temperature (25°C), but not higher temperatures. Room temperature studies are generally standardised at 20–25°C 1 8. Stability data are lacking for many antibiotics in solution above room temperature 9.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of stability data pertaining to selected antibiotics used for extended infusions in outpatient parenteral antimicrobial therapy (OPAT) at standard room temperature and in warmer climates

et al. 2019

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AimTo determine if there are sufficient stability data to confirm appropriate prescribing of antibiotics commonly used in outpatient parenteral antimicrobial therapy (OPAT) in warmer climates.Data sourcesFour databases were systematically searched using the terms ‘beta-lactams’, or ‘antibiotics’, or ‘anti-bacterial agents’ and ‘drug stability’ or drug storage’ for studies specific to drug stability published between 1966 and February 2018.Study selectionThe search strategy initially identified 2879 potential articles. After title and abstract review, the full-texts of 137 potential articles were assessed, with 46 articles matching the inclusion and exclusion criteria included in this review.ResultsA large volume of stability data is available for the selected drugs. Stability data at temperatures higher than 25°C were available for several of the medications, however few drugs demonstrated stability in warmer climates of 34°C or higher. Only buffered benzylpenicillin, cefoxitin and buffered flucloxacillin were found to have stability data supporting OPAT in warmer climates. Sequential data, profiling the drug for an extended period in solution under refrigeration prior to the run-out period at the higher temperatures, are also lacking.LimitationsThis study was limited by including only peer reviewed articles. There may be further grey literature supporting the stability of some of the drugs mentioned.ConclusionThere are insufficient stability data of antibiotic use in warmer climates. Studies to verify the stability and appropriate use of many antibiotics used in OPAT at standard room temperature and in warmer climates are urgently required. Several drugs in current use in the OPAT settings are lacking stability data.ImplicationsFurther research in this field is needed to develop structured evidence-based guidelines. Results of this review should be further compared with observed patient outcomes in current clinical practice.

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Temperature variation in the home setting: implications for continuous ambulatory infusions

Sluggett

Sharley

Reynolds

et al. 2017

Pharmacy Practice and Res

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Background Home infusion therapy is being increasingly utilised. Little is known about variation in the temperature of the infusion solution in the home and its effect on drug stability. Aim To investigate temperature changes over a 24‐h period during usual daily activities and assess the effect of ice packs on infusion solution temperature during storage at 25°C or 32°C. Method Six healthy volunteers (without intravenous access) wore a waist pouch containing an elastomeric infuser for 24 h during autumn and recorded their daily activities. Infusion solution temperature and ambient temperature were measured every 10 min. In a separate experiment, an infuser was placed inside a waist pouch containing ice packs and ambient temperature was maintained at 25°C or 32°C for 24 h. Ice packs were replaced eight‐hourly. The procedure was repeated twice at each temperature. Results The mean temperature of the infusion solutions worn by volunteers ranged from 22.7°C (±3.5) to 27.9°C (±5.6), and the cumulative time exceeding 25°C ranged 6–20 h. The infusers stored in waist pouches with ice packs usually maintained a solution temperature below 20°C when stored at 25°C. Infusers stored at 32°C maintained a solution temperature greater than 20°C for up to 11 h. Conclusion Infusion solutions may reach temperatures above 30°C in the home which should be considered when assessing patient suitability for home therapy. There is a need to assess drug stability at high temperatures and determine if exposure to high temperatures has a negative impact on therapeutic outcomes.

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Parenteral antibiotics at home

Cited by 6 publications

References 3 publications

Safety of continuous antibiotic infusions administered through an Australian hospital in the home service: a pilot study

Safety of continuous antibiotic infusions administered through an Australian hospital in the home service: a pilot study

Systematic review of stability data pertaining to selected antibiotics used for extended infusions in outpatient parenteral antimicrobial therapy (OPAT) at standard room temperature and in warmer climates

Temperature variation in the home setting: implications for continuous ambulatory infusions

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