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Monitoring Careful monitoring of patient progress, both in terms of stopping the spread of infection and of healing processes, should be reported to the health care team on a routine basis. Signs of resolution should include the reduction of tenderness, erythema, redness, regional lymphadenopathy, and other symptoms. If there is no sign of reduction of the spread or improvement during treatment within two weeks, further evaluation should be completed. Issues such as diminished blood perfusion to the infected area, metabolic abnormalities that can affect wound healing, and nutrient deficiencies should be addressed simultaneously to support resolution of infection and wound healing. In some cases, therapy may be halted or otherwise altered to reduce potential adverse effects or unacceptable health risks.
There are a number of adverse effects of parenteral antibiotic treatment. Clinical monitoring through on-site visits varies according to patient needs and may include blood draws for laboratory monitoring and physical examination to assess vascular access sites, antibiotic use, and knowledge of appropriate care by the patient and caregivers. Prevention of VAD-related problems is a priority. Selected physical and laboratory monitoring criteria will include constitutional symptoms (nausea, vomiting, diarrhea), allergic reactions, altered renal and hepatic status, anemias, fever, vestibular/hearing dysfunction, and other problems. More careful monitoring for otologic symptoms may be routine in patients receiving an aminoglycoside medication.
Laboratory tests may include medication peak and trough levels, complete blood counts, renal or liver function tests, potassium or other electrolyte levels, and others according to an estimated risk for problems associated with the prescribed antibiotic. For instance, beta-lactam medications may require less frequent renal function testing than aminoglycocides. Fluoroquinolones and oxacillin may require hepatic enzyme testing while only selected beta-lactam antibiotics may require routine liver enzyme testing. Blood glucose abnormalities are sometimes seen during the use of some antibiotics, such as levofloxacin, gatifloxacin, and ceftriaxone (Mohr et al. 2005). While about 1% or less may experience this effect, it may be especially important to monitor patients with diabetes and glucose intolerance as well as those who are on multiple medications that could contribute to dysglycemia. Treatment for hyperglycemia and hypoglycemia has been most noted in the fluoroquinolones, specifically gatofloxacin, regardless of the presence of diabetes (Park-Wyllie et al. 2006).
Special Populations Additional considerations apply to high-risk populations and patients who require additional care. Children, the elderly, patients with diabetes, and immunocompromised patients are examples of populations that will need even more careful assessment and monitoring of their IV antibiotic treatments. Clinicians should have appropriate training and skills as well as clear lines of communication with the health care team to address these special needs.
Pediatric Care Considerations Home IV antibiotic care for infants and small children requires pediatric expertise. Skilled assessment is even more crucial in the pediatric patient than in adult SSTIs. Physical examination unique to pediatric patients and the home care clinician’s capacity to apply an understanding of the manifestations of pediatric-specific complications, including toxicities, should be taken into account prior to providing intravenous antimicrobial therapy and soft tissue wound care outside of an institutional setting. Pediatric patients will require oversight by pediatric specialists. Home IV therapy will likely require a family member or caregiver who is competent to provide adequate care.
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