IV antibiotics

INTRODUCTION

Home IV administration of antibiotics has evolved dramatically over the past 15 years, and this mode of therapy has become an important tool for the management of patients requiring long-term parenteral administration of antibiotics. Many models exist for outpatient delivery of antibiotic therapy, including home-based therapy administered by a visiting nurse, self-administration, and therapy in an infusion centre. Because of the greater risks of accelerated or immediate adverse reactions associated with IV as opposed to oral drug therapy, administration of the first IV dose in a medically supervised setting is advocated by most health care professionals, as reflected in the 2004 practice guidelines of the Infectious Diseases Society of America.

This requirement may be onerous for patients who need to travel a long distance to a health care facility or physician’s office to receive the first dose, a situation that is likely to arise more frequently as fewer people are admitted to hospital and an increasing number of patients receive outpatient IV antibiotic therapy. In addition, some studies have shown that prompt administration of parenteral antimicrobial agents has improved patient outcomes, which suggests that the delay associated with obtaining physician supervision for the first dose may be detrimental to therapeutic outcomes.
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In Ontario, home IV antibiotic therapy is coordinated by regional Community Care Access Centres (CCACs) and is provided by visiting nurses from agencies hired by the CCACs. Each CCAC has its own policy governing the administration of first-dose IV antibiotic therapy. For the Kingston, Frontenac, Lennox, and Addington CCAC, the contract with the nursing agency specifies that patients must have epinephrine available throughout the course of IV therapy, to be used by the visiting nurse in case of anaphylaxis. This requirement can be contentious, since the cost of this medication is often not covered by third- party insurance.

An adverse reaction to a drug, including drugs administered intravenously, can be categorized as an exaggerated therapeutic effect, a toxic effect, or a hypersensitivity (immunologic or allergic) response. Hypersensitivity reactions to drugs have been estimated to represent up to one-third of all drug reactions, and antibiotics constitute the class of medications most commonly associated with severe allergic reactions such as anaphylaxis. Therefore, this investigation into the safety of IV therapy focused on hypersensitivity reactions to antibiotics. canadian pharmacy

This study was undertaken to evaluate the need for physician supervision of first-dose IV therapy and the need for patients to purchase epinephrine kits.