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Background Information Skin and soft tissue infections (SSTIs) are one of the primary reasons for outpatient and home antibiotic therapies. Soft tissue infections are classified according to type and complexity or severity. Examples of SSTIs and complications are defined in the Glossary. Superficial skin infections in patients with intact immune systems may clear up without additional intervention. However, when infections spread to deeper tissues or recur, antibiotic treatment may be indicated. In the home setting the system for deciding on appropriate products and care models (patient/caregiver or infusion nurse-provided administration of antibiotics) depends on a wide variety of considerations, including the ability to limit the potential for complications. Other characteristics such as medications, home environment, vascular access device types and care, anticipated duration of therapy, and other conditions determine the type of home care services and products provided. Several studies have suggested that home administration of intravenous (IV) antibiotics for SSTIs and other infections is both safe and cost-effective. For instance, home IV cephazolin therapy for cellulitis was shown to have a low re-admission rate and could result in a significant reduction of both nosocomial infections and emergency room or hospitalization costs (Donald et al. 2005). In another study, home IV administration of antibiotics for cellulitis showed similar safety and efficacy, along with a greater patient satisfaction with home therapy compared to inpatient treatment (Corwin et al. 2005). The type and severity of infection will determine optimal treatment strategies. The home setting is appropriate for patients who dont require hospitalization, who are capable or who have caregivers who are capable of delivering antibiotic therapies at home, and have a home environment that supports care. Several guidelines exist to outline best practices and recommendations for the use of intravenous antibiotic therapy in the outpatient setting. Outpatient antimicrobial therapy may be provided to approximately 1 in 1000 persons in the United States (Winters, Parver, & Sansbury 1992). The Infectious Diseases Society of America (IDSA) developed guidelines for home IV antibiotic therapy. Included in these guidelines are criteria for the appropriateness of administering the therapy in a home setting, including assurance for:
The need for
parenteral antimicrobial therapy The guidelines also emphasize the need for a team approach that includes close communications between physician, home care team nurses and pharmacists, and the patient and/or caregiver. Follow-up guidelines suggest careful monitoring for complications and outcomes that includes a range of issues such as patient response, complications and satisfaction.
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