An evidence-based algorithm to determine location and level of supervision for the first dose of IV therapy and the need for patients meeting safety criteria for home IV antibiotic therapy to purchase epinephrine kits was formulated by author consensus. The algorithm was intended for potential use by organizations and health care workers involved in coordinating, prescribing, or administering outpatient IV antibiotic therapy. Evidence was gathered using a four-pronged approach: literature review, review of the Canadian Adverse Drug Reaction Information System (CADRIS) database, survey of CCACs, and survey of health care professionals.

Literature Review

Two literature searches were performed: one for the incidence of adverse reactions to first-dose IV antibiotics and one for occurrence of anaphylaxis with home IV therapy. For both searches, the databases were Ovid MEDLINE (January 1966 to week 1 of November 2006); Ovid MEDLINE in-process and other nonindexed citations (as of November 9, 2006); EMBASE (January 1980 to week 44 of 2006); all evidence-based reviews in the Cochrane Database of Systematic Reviews, the ACP Journal Club database, the Database of Abstracts of Reviews of Effects, and the Cochrane Controlled Trials Register; International Pharmaceutical Abstracts (January 1970 to October 2006); Ovid Healthstar (January 1966 to September 2006); CINAHL (January 1982 to week 1 of November 2006); and Web of Science (January 1900 to November 2006). Unpublished data sources were not searched. Articles in all languages and articles of all types (except case series) were included. References from all relevant articles were reviewed to identify additional sources.

For the incidence of adverse reactions to first-dose IV antibiotics, the search terms were “intravenous”, “iv”, “infusion”, “antibiotic”, “antibacterial”, “anti-infective”, “allergy”, “anaphylaxis”, “side-effect”, “adverse effect”, and “hypersensitivity”, and permutations of these terms. Medical Subject Heading (MeSH) terms were {“anti¬≠bacterial agents” or “anti-infective agent, local/urinary”} and {drug hypersensitivity} and {“infusions, intravenous” or “injections, intravenous”}. Similar MeSH terms were used when searching the other databases individually as appropriate. The titles of 55 human studies were retrieved, of which 15 were excluded because they did not pertain to antibiotic treatment. Thirty-five abstracts were excluded as they did not pertain to IV therapy or to drug adverse effects, or because they were case reports. Of the remaining articles, 3 did not specify time to onset of adverse effect after start of infusion and were thus excluded. Two articles remained for analysis.¬†Apcalis Oral Jelly

For anaphylaxis in home IV therapy, the terms {“home infusion therapy” or “home intravenous therapy”} and “anaphylaxis” were used. A total of 34 articles were identified, but 30 were excluded because they did not discuss antibiotic therapy, 2 did not pertain to anaphylaxis, and 1 was a case series. Only 1 article remained, and it had also been found in the other literature search.