home IV administration

Literature Review

No studies were found specifically examining rates of anaphylaxis or other adverse events with the first dose of IV antibiotic therapy.

In an Australian prospective study of 770 patients who received the first dose of home IV therapy under medical supervision, there were no cases of anaphylaxis or other life-threatening adverse reactions. A total of 1000 courses of home IV therapy were given, with 25 different buy antibiotics online  for 37 conditions. Three patients (0.4% of the cohort) experienced delayed angioedema (with flucloxacillin in 2 cases and ceftazidime in the third case). All patients responded rapidly to withdrawal of the drug, and none required epinephrine. There were 28 allergic reactions, with a mean time to reaction of 19.6 days (range 1 to 39 days) after commencement of treatment. Dobson and others suggested that routine supply of epinephrine for anaphylaxis is not warranted, given the cost of this drug and its instability at extreme temperatures. There were also concerns about adminis­tration of epinephrine: patients may not recognize the signs of anaphylaxis, may not administer the epinephrine in time, or may not prepare the epinephrine appropriately. canadian cialis

In a prospective, randomized, double-blinded, placebo-controlled study (with 19 patients in each arm), Renz and others8 examined the efficacy of antihistamine pretreatment in preventing “red man syndrome” in patients undergoing elective orthopedic surgery and receiving vancomycin by rapid infusion (1 g over 10 min). The exclusion criteria included a history of atopy and active asthma. Although 1 patient who received antihistamine pretreatment and 12 control patients experienced hypotension and other allergic symptoms, none of the patients experienced recurrence of their symptoms or rash after a switch to the standard infusion rate for vancomycin (1 g over 1 h).

Search of CADRIS Database

Among all reactions reported in Canada between January 1, 1998, and March 31, 2006, 386 reports were compatible with anaphylaxis. Only 27 of these reports identified an IV antibiotic as the suspected medication; an additional 6 reports listed at least one IV antibiotic as a concomitant medication. 6-Lactams were the most commonly implicated (12 reports in total: cephalosporins in 8 cases, penicillins in 2, an aminoglycoside and penicillin in 1, and a cephalosporin and carbapenem in 1). Fluoroquinolones and macrolides were implicated in 4 reports each, vancomycin in 3 reports, and amphotericin B, clindamycin, aztreonam, and imipenem-cilastatin in 1 report each. Overall, cefazolin was the most commonly implicated antimicrobial (total of 7 reports). All but 2 reports indicated that patients were receiving several other medications in addition to the suspected drug. generic cialis 20mg

Fourteen of the 27 reports described the reaction as occurring on the first dose or day of IV administration of the suspected antimicrobial. In 3 cases, the patients died; 2 of the deaths were associated with anaphylactic reaction after a first dose of cefazolin. In 7 cases, the patient had not yet recovered or the outcome was unknown at the time of reporting. Recovery without sequelae was reported for the other cases.