Adverse effects of outpatient parenteral antibiotic therapy

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 26 9 patients who received 291 courses of home parenteral antimicrobial therap y through a hospital-based home infusion program during a 2-year period. Pa tients with human immunodeficiency virus (HIV) infection were not included. RESULTS: The majority (59%) of patients were treated for bone and joint inf ections. Patients had a mean age of 47 years. The mean duration of antibiot ic therapy was 40 days. Of monitored courses. leukopenia occurred in 16%, n eutropenia in 7%, thrombocytopenia in 4%, and eosinophilia in 12%, usually after a month of therapy; these adverse effects were most frequently associ ated 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, a nd bath were most commonly seen with beta-lactam antibiotics. Of those pati ents with permanent indwelling catheters, 11% of those with central cathete rs and 9% of those with peripherally inserted central catheters (PICCs) dev eloped line complications. Overall, 8% of patients required rehospitalizati on. CONCLUSION: Home infusion antibiotic therapy exposes patients to the compli cations associated with inpatient antibiotic therapy and needs to be monito red closely to prevent serious complications and rehospitalizations. Am J M ed. 1999;106:44-49. (C) 1999 by Excerpta Medica, Inc.