SAFE INTRAVENOUS ANTIBIOTIC-THERAPY AT HOME - EXPERIENCE OF A UK BASED PROGRAM

Outpatient iv antibiotic therapy is well developed in the United State s, largely because of pressures from third-party payers to reduce cost s of medical care. We have developed an outpatient iv antibiotic progr amme in Oxford, that has evolved from a desire to provide high quality iv therapy to AIDS patients with cytomegalovirus retinitis. We descri be the rationale of the service and report on our first two years' exp erience. We treated 67 consecutive patients (eight with HIV infection) at home with iv antibiotics. This resulted in a saving of 2275 hospit al days for those patients without HIV infection. HIV positive patient s received 69 months of home iv therapy. Minor intravascular catheter complications occurred in only five patients (7.5%). The only serious complications were three episodes of catheter-related sepsis (4.5%), a ll occurring in AIDS patients who had lines in for more than six month s. We have shown that home iv antibiotic therapy can be delivered safe ly to patients with a wide variety of infectious problems using the ex isting network of community nurses in the National Health Service. Ess ential components to the programme include a multidisciplinary team wo rking between the hospital and community and a written shared care pro tocol. Such a programme can result in reduced lengths of hospital stay and patient, community nurse and physician satisfaction.