|
Study 3 Citation: Howden BP, Grayson ML. Hospital-in-the-home treatment of infectious diseases. Med J Aust 2002 May 6;176(9):440-5
|
Abstract:
Note: This article was a review of previous literature on the topic of IV antibiotic treatment of cellulitis in the home setting. The authors refer to home care as hospital-in-the-home.
Howden and Grayson made six opening statements in the beginning of this study. They are paraphrased below:
1. There exists a large and growing number of infections that can be treated at home, both safely and effectively, with parenteral antimicrobial therapy. They include cellulites, deep abcesses, septic arthritis, osteomyelitis, endocarditis and pneumonia.
2. Hospital-in-the-home therapy, or HITH according to the authors, may be used with all of these patients. However, certain precautions needed to be exercised, and these include thoroughly assessing the patient for homecare suitability, including clinical and social circumstances. Also noted was that both caregiver and patient consents need to be obtained.
3. While hospital-bound, patients must be assessed weekly to monitor their progress, checking for possible complications and adverse drug reactions.
4. When choosing antibiotics, the choice should be based on prescribing principles rather than dosing convenience.
5. There are a number of drugs that can be administered somewhat uniquely that provide effective treatment for numerous infections that in the past would have required hospitalization. These drugs include oral fluoroquinolones (ciprofloxacin), once-daily aminoglycosides, continuous-infusion beta-lactams (flucoxacillin), and once or twice-daily cephalosporins (cephazolin).
6. HITH is an effective treatment option and can lead to improved satisfaction among both patients and caregivers, as well as the more obvious benefits of increased hospital bed efficiencies and financial considerations.
Key words:
hospital-in-the-home, aminoglcosides, beta-lactams, cephalosporins, fluoroquinolones
| This third study’s findings nicely coincided with the first two studies included in this Journal Club (Howden et al. and Grayson et al). Namely, the authors found IV antibiotics to be both clinically and cost effective, and preferential as treatment for cellulitis and other infections in the home setting. |