Journal Club

IV Antibiotics: Focus on Cellulitis

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Obviously there is a need for the practicing social worker to be aware of the issues surrounding the cellulitis patient. The patients described in this Journal Club are receiving IV antibiotics, a fairly invasive therapy in itself, and suffer from a skin infection that can have a pronounced effect on how they are perceived (and how they perceive themselves). There is a financial consideration here, as well. IV antibiotic therapy can last for several weeks, with the patient's insurance usually picking up the majority of this cost. And then there is compliance. Patients receiving home infusion may be taught to self-administer, which requires the patient (and/or caregiver or family member) to clean the infusion site, be familiar with the infusion equipment and administration methods, and have the discipline to do this at the designated times.

Perhaps the biggest concerns with the cellulitis patient are the psychosocial ones. Patients may have one site that is infected, and it may be confined to an area that can be covered up by clothing. However, the cellulitis may be in several areas or in places where clothing cannot cover it up (or covering it up is not recommended by their health care professional). These patients may suffer from anxiety at being seen in public, or from even going in to see their doctor. In the worst case, the patient may not even want their caregiver to see them. This is an extreme to be sure, but should be taken into consideration. Additionally, intravenous infusions can have a deleterious effect on a patient that considered themselves to be healthy (other than their cellulitis). Now that they have an indwelling catheter, however temporary, they may see themselves as sicker than they really are. Morale can suffer, and so can the length of their convalescence.

The studies presented in this Journal Club primarily look at treating moderate to severe cellulitis with IV antibiotics. Physical issues are dealt with, as are medical complications that can arise from this form of treatment. It is, therefore, the role of the social worker to determine the patient's psychosocial condition and treat them accordingly.