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Journal articles on the topic 'Intravenous antibiotics'

Author: Grafiati
Published: 4 June 2021
Last updated: 6 February 2022

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1

Niimi, Rui, Masahiro Hasegawa, Goshin Kawamura, and Akihiro Sudo. "One-Day Antibiotic Infusion for the Prevention of Postoperative Infection Following Arthroplasty: A Case Control Study." ISRN Orthopedics 2011 (July 5, 2011): 1–4. http://dx.doi.org/10.5402/2011/839641.

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Intravenous antibiotics effectively reduce the prevalence of postoperative infection. However, Japanese orthopaedic surgeons have no consensus with regard to the optimal duration of prophylaxis. The aim of this study is to compare the outcome of one-day intravenous antibiotic administration with that of long-term intravenous antibiotic administration. Patients who underwent total hip or knee arthroplasty were divided into 2 groups to receive one of 2 prophylactic protocols retrospectively. Group A (223 patients) received intravenous antibiotics twice only on the day of surgery, whereas Group B (104 patients) received intravenous antibiotics for at least 3 days after surgery. We analyzed the wound infection rate and monitored liver and renal functions. None of these patients had a postoperative infection. No liver dysfunction and renal dysfunction were observed. One-day antibiotic infusion was as effective as long-term antibiotics in preventing infection after arthroplasty and achieved greater cost effectiveness.
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2

Connor, Kathryn A. "New Intravenous Antibiotics." AACN Advanced Critical Care 21, no. 3 (2010): 237–40. http://dx.doi.org/10.1097/nci.0b013e3181e06091.

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3

&NA;. "New Intravenous Antibiotics." AACN Advanced Critical Care 21, no. 3 (2010): 241–42. http://dx.doi.org/10.1097/nci.0b013e3181efbfdc.

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4

Nguyen, Phuong TK, Hoang T. Tran, Dominic A. Fitzgerald, Steve M. Graham, and Ben J. Marais. "Antibiotic use in children hospitalised with pneumonia in Central Vietnam." Archives of Disease in Childhood 105, no. 8 (February 20, 2020): 713–19. http://dx.doi.org/10.1136/archdischild-2019-317733.

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Background and objectivesExcessive use of antibiotics has been noted in children with respiratory tract infections in Vietnam, but antibiotic use in hospitalised children is poorly documented. Antibiotic use and direct healthcare costs in children hospitalised with pneumonia in central Vietnam were assessed.MethodsA prospective descriptive study of children under 5 years old admitted with a primary admission diagnosis of ‘pneumonia’ to the Da Nang Hospital for Women and Children over 1 year.ResultsOf 2911 children hospitalised with pneumonia, 2735 (94.0%) were classified as ‘non-severe’ pneumonia by the admitting physician. In total, 2853 (98.0%) children received antibiotics. Intravenous antibiotics were given to 336 (12.3%) children with ‘non-severe’ and 157/176 (89.2%) children with ‘severe’ pneumonia; those with ‘non-severe’ pneumonia accounted for 68.2% (336/493) of intravenous antibiotics given. Only 19.3% (95/493) of children on intravenous antibiotics were stepped down to an oral antibiotic. Cefuroxime was the preferred oral agent, and ceftriaxone was the preferred injectable agent. Hospital admission for oral antibiotics in ‘non-severe’ pneumonia was a major cost driver, with an average direct cost of US$78.9 per patient, accounting for 54.0% of the total hospitalisation cost in the study cohort. In addition, 336 (12.3%) children with non-severe pneumonia received intravenous antibiotics without indication, accounting for a further 23.2% of hospitalisation costs.ConclusionLimiting unnecessary hospitalisation and considering early intravenous to oral step down antibiotic will reduce direct health system costs and morbidity in children with respiratory tract infections in Vietnam.
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5

Coulthard, M. G., and W. H. Lamb. "ANTIBIOTICS: INTRAMUSCULAR OR INTRAVENOUS?" Lancet 326, no. 8462 (November 1985): 1015. http://dx.doi.org/10.1016/s0140-6736(85)90567-7.

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6

Chuong, Robert. "Intravenous antibiotics: Avoiding complications." Journal of Oral and Maxillofacial Surgery 43, no. 5 (May 1985): 395. http://dx.doi.org/10.1016/0278-2391(85)90272-1.

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7

Konarzewski, W. H., I. H. Wilson, and P. Burke. "Intravenous antibiotics and gangrene." Anaesthesia 40, no. 11 (November 1985): 1141. http://dx.doi.org/10.1111/j.1365-2044.1985.tb10637.x.

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8

Tsang, P. "Oral versus intravenous antibiotics." BMJ 311, no. 7006 (September 9, 1995): 685. http://dx.doi.org/10.1136/bmj.311.7006.685a.

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9

DAVIS, JANET L. "Intravenous Antibiotics for Endophthalmitis." American Journal of Ophthalmology 122, no. 5 (November 1996): 724–26. http://dx.doi.org/10.1016/s0002-9394(14)70493-3.

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10

HARRIS, LeROY F., THOMAS F. BUCKLE, and FRED L. COFFEY. "Intravenous Antibiotics at Home." Southern Medical Journal 79, no. 2 (February 1986): 193–96. http://dx.doi.org/10.1097/00007611-198602000-00014.

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11

Durand, Marlene L. "Intravenous antibiotics in sinusitis." Current Opinion in Otolaryngology & Head and Neck Surgery 7, no. 1 (February 1999): 7. http://dx.doi.org/10.1097/00020840-199902000-00003.

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12

McCarthy, Kate, and Minyon Avent. "Oral or intravenous antibiotics?" Australian Prescriber 43, no. 2 (April 1, 2020): 45–48. http://dx.doi.org/10.18773/austprescr.2020.008.

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13

Carter, Beverley. "Bringing intravenous antibiotics home." British Journal of Nursing 24, Sup19 (October 21, 2015): S3. http://dx.doi.org/10.12968/bjon.2015.24.sup19.s3.

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14

Suzuki, Toshiyuki, Sotaro Sadahiro, Akira Tanaka, Kazutake Okada, Gota Saito, Hiroshi Miyakita, and Takashi Ogimi. "Usefulness of Preoperative Mechanical Bowel Preparation in Patients with Colon Cancer who Undergo Elective Surgery: A Prospective Randomized Trial Using Oral Antibiotics." Digestive Surgery 37, no. 3 (May 3, 2019): 192–98. http://dx.doi.org/10.1159/000500020.

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Background: To prevent surgical site infection (SSI) in colorectal surgery, the combination of mechanical bowel preparation (MBP), oral antibiotic bowel preparation (OABP), and the intravenous antibiotics have been proposed as standard treatment. We conducted an RCT comparing the incidence of SSI between MBP + OABP and OABP alone after receiving a single dose of intravenous antibiotics. Methods: The study group comprised 254 patients who underwent elective surgery for colon cancer. Patients were randomly assigned to receive MBP + OABP and intravenous antibiotics (MBP + OABP group) or to receive OABP and intravenous antibiotics (OABP alone group). Results: Overall, 125 patients in MBP + OABP group and 126 patients in OABP alone group were eligible. Incisional SSI occurred in 3 patients (2.4%) in MBP + OABP group, and 8 patients (6.3%) in the OABP-alone group. Organ/space SSI developed in 0 patients (0%) and in 4 patients (3.2%) in each group respectively. The OABP-alone group was thus not shown to be noninferior to the MBP + OABP group in the incidences of incisional SSI or organ/space SSI. Other infectious complications developed in 7 patients (5.6%) and in 6 patients (4.8%) in each group, indicating the non-inferiority of OABP alone to MBP + OABP. Conclusions: MBP combined with oral antibiotics and intravenous antibiotics remains standard in elective colon cancer surgery.
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15

Karr, Jeffrey C. "Lower-Extremity Osteomyelitis Treatment Using Calcium Sulfate/Hydroxyapatite Bone Void Filler with Antibiotics." Journal of the American Podiatric Medical Association 108, no. 3 (May 1, 2018): 210–14. http://dx.doi.org/10.7547/16-096.

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Background: Over a 74-month period (∼6 years), 143 lower-extremity osteomyelitis locations in 125 patients were treated with a calcium sulfate/hydroxyapatite liquid bone void filler with antibiotic(s). Methods: The osteomyelitis locations were treated with a percutaneous antibiotic delivery technique delivering intraosseous antibiotic followed by either oral or intravenous antibiotics for 4 weeks. Results: There was no recurrence of osteomyelitis in 96.15% of the treatable patients. Outcomes classified by the Cierny-Mader clinical classification are discussed as well. Conclusions: A bone void filler with antibiotic(s) using the percutaneous antibiotic delivery technique is a safe, reliable, and effective means to treat lower-extremity osteomyelitis with either oral or intravenous antibiotics for 4 weeks.
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16

Lang, Selwyn D. R. "Oral Ciprofloxacin versus Intravenous Antibiotics." PharmacoEconomics 2, no. 1 (July 1992): 87–88. http://dx.doi.org/10.2165/00019053-199202010-00010.

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17

Zavascki, Alexandre P. "Continuous intravenous administration of antibiotics." Lancet Infectious Diseases 6, no. 5 (May 2006): 259. http://dx.doi.org/10.1016/s1473-3099(06)70446-7.

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18

Le Bras, Alexandra. "Endocarditis: oral versus intravenous antibiotics." Nature Reviews Cardiology 15, no. 11 (September 20, 2018): 653. http://dx.doi.org/10.1038/s41569-018-0095-8.

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19

SAMBRANO, BRITTANY, RACHEL GORDON, RANA MAYS, WHITNEY LAPOLLA, and NOAH SCHEINFELD. "Intravenous antibiotics used in dermatology." Dermatologic Therapy 25, no. 1 (January 2012): 70–81. http://dx.doi.org/10.1111/j.1529-8019.2012.01533.x.

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20

Moehring, H. David, Charles Gravel, Michael W. Chapman, and Steven A. Olson. "Comparison of Antibiotic Beads and Intravenous Antibiotics in Open Fractures." Clinical Orthopaedics and Related Research 372 (March 2000): 254–61. http://dx.doi.org/10.1097/00003086-200003000-00028.

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21

Mann, Nina, Shirley Murray, Zhe Hui Hoo, Rachael Curley, and Martin J. Wildman. "Case Report: Dual nebulised antibiotics among adults with cystic fibrosis and chronic Pseudomonas infection." F1000Research 6 (December 1, 2017): 2079. http://dx.doi.org/10.12688/f1000research.13298.1.

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Pulmonary exacerbations in adults with cystic fibrosis (CF) and chronic Pseudomonas aeruginosa (Psae) infection are usually treated with dual intravenous antibiotics for 14 days, despite the lack of evidence for best practice. Intravenous antibiotics are commonly associated with various systemic adverse effects, including renal failure and ototoxicity. Inhaled antibiotics are less likely to cause systematic adverse effects, yet can achieve airway concentrations well above conventional minimum inhibitory concentrations. Typically one inhaled antibiotic is used at a time, but dual inhaled antibiotics (i.e. concomitant use of two different inhaled antibiotics) may have synergistic effect and achieve better results in the treatment of exacerbations. We presented anecdotal evidence for the use of dual inhaled antibiotics as an acute treatment for exacerbations, in the form of a case report. A female in her early thirties with CF and chronic Psae infection improved her FEV1 by 5% and 2% with two courses of dual inhaled antibiotics to treat exacerbations in 2016. In contrast, her FEV1 changed by 2%, –2%, 0% and 2%, respectively, with four courses of dual intravenous antibiotics in 2016. Baseline FEV1 was similar prior to all six courses of treatments. The greater FEV1 improvements with dual inhaled antibiotics compared to dual intravenous antibiotics suggest the potential role of using dual inhaled antibiotics to treat exacerbations among adults with CF and chronic Psae infection, especially since a greater choice of inhaled anti-pseudomonal antibiotics is now available. A previous study in 1985 has looked at the concomitant administration of inhaled tobramycin and carbenicillin, by reconstituting antibiotics designed for parenteral administration. To our knowledge, this is the first literature to describe the concomitant use of two different antibiotics specifically developed for delivery via the inhaled route.
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22

Mann, Nina, Shirley Murray, Zhe Hui Hoo, Rachael Curley, and Martin J. Wildman. "Case Report: Dual nebulised antibiotics among adults with cystic fibrosis and chronic Pseudomonas infection." F1000Research 6 (February 28, 2018): 2079. http://dx.doi.org/10.12688/f1000research.13298.2.

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Pulmonary exacerbations in adults with cystic fibrosis (CF) and chronic Pseudomonas aeruginosa (Psae) infection are usually treated with dual intravenous antibiotics for 14 days, despite the lack of evidence for best practice. Intravenous antibiotics are commonly associated with various systemic adverse effects, including renal failure and ototoxicity. Inhaled antibiotics are less likely to cause systematic adverse effects, yet can achieve airway concentrations well above conventional minimum inhibitory concentrations. Typically one inhaled antibiotic is used at a time, but dual inhaled antibiotics (i.e. concomitant use of two different inhaled antibiotics) may have synergistic effect and achieve better results in the treatment of exacerbations. We presented anecdotal evidence for the use of dual inhaled antibiotics as an acute treatment for exacerbations, in the form of a case report. A female in her early thirties with CF and chronic Psae infection improved her FEV1 by 5% and 2% with two courses of dual inhaled antibiotics to treat exacerbations in 2016. In contrast, her FEV1 changed by 2%, –2%, 0% and 2%, respectively, with four courses of dual intravenous antibiotics in 2016. Baseline FEV1 was similar prior to all six courses of treatments. The greater FEV1 improvements with dual inhaled antibiotics compared to dual intravenous antibiotics suggest the potential role of using dual inhaled antibiotics to treat exacerbations among adults with CF and chronic Psae infection, especially since a greater choice of inhaled anti-pseudomonal antibiotics is now available. A previous study in 1985 has looked at the concomitant administration of inhaled tobramycin and carbenicillin, by reconstituting antibiotics designed for parenteral administration. To our knowledge, this is the first literature to describe the concomitant use of two different antibiotics specifically developed for delivery via the inhaled route.
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23

Cotter, Jillian M., Matt Hall, Sonya Tang Girdwood, John R. Stephens, Jessica L. Markham, James C. Gay, and Samir S. Shah. "Opportunities for Stewardship in the Transition From Intravenous to Enteral Antibiotics in Hospitalized Pediatric Patients." Journal of Hospital Medicine 16, no. 2 (February 1, 2021): 70–76. http://dx.doi.org/10.12788/jhm.3538.

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BACKGROUND/OBJECTIVE: Pediatric patients hospitalized with bacterial infections often receive intravenous (IV) antibiotics. Early transition to enteral antibiotics can reduce hospital duration, cost, and complications. We aimed to identify opportunities to transition from IV to enteral antibiotics, describe variation of transition among hospitals, and evaluate feasibility of novel stewardship metrics. METHODS: This multisite retrospective cohort study used the Pediatric Health Information System to identify pediatric patients hospitalized with pneumonia, neck infection, orbital infection, urinary tract infection (UTI), osteomyelitis, septic arthritis, or skin and soft tissue infection (SSTI) between 2017 and 2018. Opportunity days were defined as days on which patients received both IV antibiotics and enteral medications, suggesting enteral tolerance. Percent opportunity was defined as opportunity days divided by days on any antibiotics. Both outcomes excluded IV antibiotics that have no alternative oral formulation. We evaluated outcomes per infection and antibiotic and assessed across-hospital variation. RESULTS: We identified 88,522 aggregate opportunity days in 100,103 hospitalizations. On 57% of the antibiotic days, there was an opportunity to switch patients to enteral therapy, with greatest opportunity days in SSTI, neck infection, and pneumonia encounters, and with clindamycin, ceftriaxone, and ampicillin-sulbactam. Percent opportunity varied by infection (73% in septic arthritis to 40% in pneumonia). There was significant across-hospital variation in percent opportunity for all infections. CONCLUSION: This multicenter study demonstrated the potential opportunity to transition from IV to enteral therapy in over half of antibiotic days. Opportunity varied by infection, antibiotic, and hospital. Across-hospital variation demonstrated likely missed opportunities for earlier transition and the need to define optimal transition times. Stewardship efforts promoting earlier transition for highly bioavailable antibiotics could reduce healthcare utilization and promote high-value care. We identified feasible stewardship metrics.
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24

Shah, Neel B., Beverly L. Hersh, Alex Kreger, Aatif Sayeed, Andrew G. Bullock, Scott D. Rothenberger, Brian Klatt, Brian Hamlin, and Kenneth L. Urish. "Benefits and Adverse Events Associated With Extended Antibiotic Use in Total Knee Arthroplasty Periprosthetic Joint Infection." Clinical Infectious Diseases 70, no. 4 (April 4, 2019): 559–65. http://dx.doi.org/10.1093/cid/ciz261.

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Abstract Background Total knee arthroplasty (TKA) periprosthetic joint infection (PJI) can be managed with debridement, antibiotic therapy, and implant retention (DAIR). Oral antibiotics can be used after DAIR for an extended time period to improve outcomes. The objective of this study was to compare DAIR failure rates and adverse events between an initial course of intravenous antibiotic therapy and the addition of extended treatment with oral antibiotics. Methods A multicenter observational study of patients diagnosed with a TKA PJI who underwent DAIR was performed. The primary outcome of interest was the failure rate derived from the survival time between the DAIR procedure and future treatment failure. Results One hundred eight patients met inclusion criteria; 47% (n = 51) received an extended course of oral antibiotics. These patients had a statistically significant lower failure rate compared to those who received only intravenous antibiotics (hazard ratio, 2.47; P = .009). Multivariable analysis demonstrated that extended antibiotics independently predicted treatment success, controlling for other variables. There was no significant difference in failure rates between an extended course of oral antibiotics less or more than 12 months (P = .23). No significant difference in the rates of adverse events was observed between patients who received an initial course of antibiotics alone and those who received a combination of initial and extended antibiotic therapy (P = .59). Conclusions Extending therapy with oral antibiotics had superior infection-free survival for TKA PJI managed with DAIR. There was no increase in adverse events, demonstrating safety. After 1 year, there appears to be no significant benefit associated with continued antibiotic therapy.
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25

Bhat, Ramitha R., Prerna Batra, Ravi Sachan, and Gurbachan Singh. "Neonatal ventriculitis: a case series and review of literature." Tropical Doctor 50, no. 3 (May 31, 2020): 266–70. http://dx.doi.org/10.1177/0049475520927626.

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Ventriculitis after meningitis is a serious complication in the neonatal age group. The role of intraventricular antibiotics in treatment is controversial. We present five such cases which were refractory to conventional intravenous antibiotic therapy, had persistent features of ventriculitis and in whom raised intracranial pressure (ICP) necessitated insertion of an external ventricular drain (EVD). Three of the five infants required intraventricular antibiotics but also developed EVD-related complications. Early diagnosis of ventriculitis and treatment is necessary to avoid a fatal outcome. Intravenous antibiotics are the treatment of choice, but intraventricular therapy may be considered in refractory cases. As the incidence of EVD-associated ventriculitis is high, proper care of EVDs and their early removal is mandatory.
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26

Varghese, Lalee, Suma Susan Mathews, John Antony Jude Prakash, and V. Rupa. "Deep head and neck infections: outcome following empirical therapy with early generation antibiotics." Tropical Doctor 48, no. 3 (May 14, 2018): 179–82. http://dx.doi.org/10.1177/0049475518774472.

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In order to study the bacteriological profile, antibiotic sensitivity and outcome following empirical therapy with early generation antibiotics in patients with deep head and neck infection, a retrospective review of 42 patients admitted for drainage and intravenous antibiotic therapy was performed. Ludwig’s angina was the commonest infection, with the most common organisms isolated being Group F ß-haemolytic (15%) and non-haemolytic (12.5%) streptococcus. All streptococci and anaerobic gram-positive cocci were susceptible to penicillin. S. aureus isolates were oxacillin-sensitive and enterococcus isolates were ampicillin-sensitive. All 42 patients received empirical therapy with either intravenous penicillin or its derivatives. In only three patients was a change of antibiotic required based on culture and sensitivity results. Early generation antibiotics appear ideal as empirical therapy for deep head and neck infection.
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27

Ogawa, Keiko, Koji Nishijima, Fumio Futagami, Takashi Nakamura, and Genichi Nishimura. "Effectiveness of Traditional Japanese Herbal (Kampo) Medicine, Daiobotanpito, in Combination with Antibiotic Therapy in the Treatment of Acute Diverticulitis: A Preliminary Study." Evidence-Based Complementary and Alternative Medicine 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/305414.

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In traditional Japanese herbal (Kampo) medicine, daiobotanpito (DBT) or Da Huang Mu Dan Tang in Chinese has been used in medical treatment of acute diverticulitis for many years based on the experience. Our aim was to investigate whether the treatment of acute diverticulitis can be treated with intravenous antibiotics plus orally administrated DBT than intravenous antibiotics alone. A retrospective nonrandomized open-label trial was established to compare patients with acute diverticulitis who received oral DBT associated with intravenous antibiotics with those who received intravenous antibiotic alone. We included 34 patients, eleven patients in group 1 with DBT and 23 patients in group 2 without DBT. Both groups were comparable in patient demographics and clinical characteristics. There was a significantly better outcome in the group treated with DBT than in the group without DBT when comparing duration of fever, abdominal pain, and antibiotics administration. A trend toward a day shorter mean hospital stay and fasting was seen in group 1, although this did not reach statistical significance. In conclusion, most patients with acute diverticulitis can be managed safely with oral DBT. Although randomized, double-blind study must be done, we could show the possibility to use daiobotanpito as an additional option in treating acute diverticulitis.
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SIMONE, CLAUDIO DE, GIOVANNA DELOGU, and GIOVANNI CORBETTA. "Intravenous immunoglobulins in association with antibiotics." Critical Care Medicine 16, no. 1 (January 1988): 23–26. http://dx.doi.org/10.1097/00003246-198801000-00005.

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29

Gross, Neil D., Renae J. A. McInnes, and Peter H. Hwang. "Outpatient Intravenous Antibiotics for Chronic Rhinosinusitis." Laryngoscope 112, no. 10 (October 2002): 1758–61. http://dx.doi.org/10.1097/00005537-200210000-00009.

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30

Powell, Neil, and Michael Wilcock. "Challenging the supremacy of intravenous antibiotics." Drug and Therapeutics Bulletin 57, no. 1 (December 19, 2018): 2. http://dx.doi.org/10.1136/dtb.2018.000042.

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31

Li, Ho Kwong, Ambrose Agweyu, Mike English, and Philip Bejon. "An Unsupported Preference for Intravenous Antibiotics." PLOS Medicine 12, no. 5 (May 19, 2015): e1001825. http://dx.doi.org/10.1371/journal.pmed.1001825.

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32

Hittel, William P., Daryl H. Appleby, and Robert E. Wren. "Medicare reimbursement for outpatient intravenous antibiotics." American Journal of Health-System Pharmacy 42, no. 8 (August 1, 1985): 1712–14. http://dx.doi.org/10.1093/ajhp/42.8.1712.

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33

Chowdhury, Jehan, Robin Patel, and Henry Chambers. "Oral versus Intravenous Antibiotics for Endocarditis." New England Journal of Medicine 385, no. 12 (September 16, 2021): 1141–43. http://dx.doi.org/10.1056/nejmclde2108866.

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34

Oneschuk, Doreen, Robin Fainsinger, and Donna Demoissac. "Antibiotic Use in the Last Week of Life in Three Different Palliative Care Settings." Journal of Palliative Care 18, no. 1 (March 2002): 25–28. http://dx.doi.org/10.1177/082585970201800105.

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The purpose of this study was to examine the frequency and types of antibiotics prescribed in the last week of life in three different palliative care settings, including an acute care hospital, tertiary palliative care unit, and three hospice units. A total of 150 consecutive patients were evaluated, 50 in each of the three settings. Twenty-nine patients (58%) in the acute hospital setting, 26 (52%) in the tertiary palliative care unit, and 11(22%) in the hospice settings were prescribed antibiotics. In the acute care and tertiary palliative care settings, the most frequent route of antibiotic administration was intravenous and, in the hospice setting, oral. We conclude that there is marked variability in the numbers and types of antibiotics prescribed in these different palliative care settings in the last week of life. The high use of intravenous antibiotics and the large number of patients who were still receiving antibiotics at the time of death indicate the need for further prospective studies.
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35

Seaton, R. A., N. D. Ritchie, F. Robb, L. Stewart, B. White, and C. Vallance. "From ‘OPAT’ to ‘COpAT’: implications of the OVIVA study for ambulatory management of bone and joint infection." Journal of Antimicrobial Chemotherapy 74, no. 8 (April 15, 2019): 2119–21. http://dx.doi.org/10.1093/jac/dkz122.

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AbstractBone and joint infection contributes significantly to clinical activity within outpatient parenteral antimicrobial therapy (OPAT) services. The OVIVA (oral versus intravenous antibiotics for bone and joint infection) randomized study has challenged the practice of prolonged intravenous therapy, because non-inferiority of oral antibiotic therapy was demonstrated, thereby implying that early transition to oral therapy is an appropriate alternative to prolonged intravenous therapy. We examine the caveats to the study and discuss the implications for OPAT practice, highlighting the importance of careful oral antibiotic selection with attention to bioavailability, bone penetration, drug interactions, compliance and toxicity monitoring. We emphasize that ambulatory antibiotic therapy (whether intravenous or oral) in this patient group requires expert multidisciplinary management, monitoring and follow-up, and ideally should be undertaken within existing OPAT or, more accurately, complex outpatient antibiotic therapy (COpAT) services.
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36

Colangeli, Hailey N., Brie N. Noble, Christopher J. Crnich, Jessina C. McGregor, David T. Bearden, Dominic Chan, Jon P. Furuno, and Jon P. Furuno. "200. Frequency and Characteristics of Patients Switched from Intravenous to Oral Antibiotic Therapy on Discharge to Nursing Homes." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S104—S105. http://dx.doi.org/10.1093/ofid/ofaa439.244.

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Abstract Background Determining eligibility for intravenous (IV) to oral (PO) antibiotic conversion is challenging in patients transitioning to nursing homes (NHs) due to atypical infection presentation, increased diagnostic uncertainty, and multimorbidity. Understanding current practice and patient characteristics influencing prescriber behavior is necessary to provide effective antibiotic stewardship in this vulnerable population. We compared the frequency and characteristics of patients discharged with IV antibiotics to those switched from IV to PO therapy. Methods This was a retrospective cohort study of Oregon Health & Science University Hospital patients treated with IV antibiotics and discharged to a NH from 1/1/2016-12/31/2018. We focused on IV to PO antibiotic switch within 48 hours of discharge. Using a repository of electronic health record data, we collected patient demographic, diagnosis, length of stay, and treatment duration data. Results Among 2,410 patients discharged to a NH on antibiotics, 1,483 (61.5%) received an IV antibiotic within 48 hours of discharge. IV to PO switch occurred in 46.7% of patients prior to discharge, and these patients had fewer baseline comorbidities (Table 1). Of those continuing IV antibiotics, 96.1% were prescribed a different PO medication at discharge indicating potential to take PO medications. Cephalosporins (45%) and penicillins (22%) were the most commonly prescribed IV antibiotics, with IV to PO conversion rates of 26% and 46%, respectively. The median (interquartile range) outpatient duration of therapy was 21 (12–33) days for IV antibiotics and 7 (4–10) days for PO antibiotics. Osteomyelitis diagnosis was more frequent among IV therapy patients; pneumonia and urinary tract infections were more frequent in IV to PO switch patients. IV to PO switch patients were less likely to experience a hospital stay > 7 days or receive an infectious disease consult (p < 0.001). Table 1. Comparison of Patient and Treatment Characteristics among IV and Oral Antibiotic Prescriptions on Discharge Conclusion The proportion of patients discharged to a NH on IV antibiotics remains high, even among patients able to tolerate PO medication. Continuing IV therapy was associated with longer treatment durations, hospital stays, and broad spectrum regimens, while patients with IV to PO switch had a higher comorbidity burden at baseline. Disclosures All Authors: No reported disclosures
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37

De, S., Z. G. G. Makura, and R. W. Clarke. "Paediatric acute mastoiditis: the Alder Hey experience." Journal of Laryngology & Otology 116, no. 6 (June 2002): 440–42. http://dx.doi.org/10.1258/0022215021911239.

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Acute mastoiditis was a common condition in the pre-antibiotic era, but has become rare now with the widespread use of antibiotics.A retrospective study was carried out of patients with acute mastoiditis who were seen at Alder Hey Children’s Hospital, Liverpool over a five-year period. Their case records were identified and details of gender, age at presentation, symptoms, signs and clinical management were noted and analysed.Twenty-one patients who presented with acute mastoiditis were identified. The patients’ age at presentation ranged from three months to 14 years. Five cases out of 21 (23.8 per cent) were under one year of age.Eighteen cases (85.7 per cent) presented with post-aural swelling while 12 (57.1 per cent) had aural discharge.All patients were treated with intravenous antibiotics and only five patients (23.8 per cent) required surgical intervention in the form of a cortical mastoidectomy with, or without, myringotomy.A significant number of cases can be treated conservatively with intravenous antibiotics. Surgery in the form of cortical mastoidectomy can be reserved for complicated cases and in those in whom conservative treatment has failed.
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Molton, James S., Monica Chan, Shirin Kalimuddin, Jolene Oon, Barnaby E. Young, Jenny G. Low, Brenda M. A. Salada, et al. "Oral vs Intravenous Antibiotics for Patients With Klebsiella pneumoniae Liver Abscess: A Randomized, Controlled Noninferiority Study." Clinical Infectious Diseases 71, no. 4 (October 23, 2019): 952–59. http://dx.doi.org/10.1093/cid/ciz881.

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Abstract Background Klebsiella pneumoniae liver abscess (KLA) is emerging worldwide due to hypermucoviscous strains with a propensity for metastatic infection. Treatment includes drainage and prolonged intravenous antibiotics. We aimed to determine whether oral antibiotics were noninferior to continued intravenous antibiotics for KLA. Methods This noninferiority, parallel group, randomized, clinical trial recruited hospitalized adults with liver abscess and K. pneumoniae isolated from blood or abscess fluid who had received ≤7 days of effective antibiotics at 3 sites in Singapore. Patients were randomized 1:1 to oral (ciprofloxacin) or intravenous (ceftriaxone) antibiotics for 28 days. If day 28 clinical response criteria were not met, further oral antibiotics were prescribed until clinical response was met. The primary endpoint was clinical cure assessed at week 12 and included a composite of absence of fever in the preceding week, C-reactive protein <20 mg/L, and reduction in abscess size. A noninferiority margin of 12% was used. Results Between November 2013 and October 2017, 152 patients (mean age, 58.7 years; 25.7% women) were recruited, following a median 5 days of effective intravenous antibiotics. A total of 106 (69.7%) underwent abscess drainage; 71/74 (95.9%) randomized to oral antibiotics met the primary endpoint compared with 72/78 (92.3%) randomized to intravenous antibiotics (risk difference, 3.6%; 2-sided 95% confidence interval, −4.9% to 12.8%). Effects were consistent in the per-protocol population. Nonfatal serious adverse events occurred in 12/72 (16.7%) in the oral group and 13/77 (16.9%) in the intravenous group. Conclusions Oral antibiotics were noninferior to intravenous antibiotics for the early treatment of KLA. Clinical Trials Registration NCT01723150.
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Yoder, Milton G., and Thomas A. Weimert. "Antibiotics and Topical Surgical Preparation Solution in Septal Surgery." Otolaryngology–Head and Neck Surgery 106, no. 3 (March 1992): 243–44. http://dx.doi.org/10.1177/019459989210600307.

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One thousand forty patients undergoing septal surgery of the nose were included in this 5-year study of no prophylactic antibiotics and no topical surgical preparation solution before surgery. Minor nasal infections developed in only five patients (0.48%) postoperatively. All five of these patients responded to oral antibiotic therapy and did not require hospitalization or intravenous antibiotic treatment. The incidence of infectious complications resulting from nasal surgery without the use of topical surgical preparation solution and without prophylactic antibiotics is minimal. No topical surgical preparation solution and no prophylactic antibiotic technique is a safe and acceptable approach for septoplasty and rhinoplasty surgery.
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40

Morgan, MR, JS Gaynor, and E. Monnet. "The effects of sodium ampicillin, sodium cefazolin, and sodium cefoxitin on blood pressures and heart rates in healthy, anesthetized dogs." Journal of the American Animal Hospital Association 36, no. 2 (March 1, 2000): 111–14. http://dx.doi.org/10.5326/15473317-36-2-111.

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This study determined the effects of intravenous ampicillin, cefazolin, and cefoxitin on blood pressures and heart rates in healthy, anesthetized dogs. Forty dogs were each randomly assigned to a control, ampicillin, cefazolin, or cefoxitin group. Antibiotics or saline was delivered by intravenous bolus prior to surgical stimulation. Heart rate; systolic, mean, and diastolic arterial pressures; oxygen saturation; end-tidal halothane; and end-tidal carbon dioxide (CO2) were recorded before and every minute for 10 minutes after the test drug was administered. No significant differences were recorded between the antibiotic and control groups. The prophylactic use of these antibiotics should be considered safe in healthy, anesthetized dogs.
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Kamfose, Musaiwale M., Francis G. Muriithi, Thomas Knight, Daniel Lasserson, and Gail Hayward. "Intravenous Ceftriaxone Versus Multiple Dosing Regimes of Intravenous Anti-Staphylococcal Antibiotics for Methicillin-Susceptible Staphylococcus aureus (MSSA): A Systematic Review." Antibiotics 9, no. 2 (January 21, 2020): 39. http://dx.doi.org/10.3390/antibiotics9020039.

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Background: Methicillin-susceptible Staphylococcus aureus (MSSA) is a common pathogen associated with a range of clinically important infections. MSSA can cause deep-seated infections requiring prolonged courses of intravenous antibiotic therapy to achieve effective resolution. The move toward ambulatory or outpatient delivery of parenteral antibiotics has led to an increase in the use of ceftriaxone as a pragmatic first choice given its advantageous single daily dosing schedule. Objective: To compare the efficacy of once daily ceftriaxone in the treatment of infections due to confirmed or suspected MSSA to multiple dosing regimes of anti-staphylococcal antibiotics. Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Global Health, PubMed, EMBASE and CINAHL for randomised controlled trials as well as prospective and retrospective cohort studies that compared ceftriaxone to any multiple dosing regime of anti-staphylococcal antibiotics. Outcome measures were the proportion of patients with a resolution of infection based on time after initiation of therapy, adverse reactions, recurrence and duration of hospital admission. Results: We included two randomized controlled trials, one prospective observational study and three retrospective cohort studies (643 participants; 246 children, 397 adults). There was no difference in time to resolution of symptoms. The number of adverse reactions, recurrence of bacteraemia and duration of hospital stay were not significantly different between ceftriaxone and other anti-staphylococcal antibiotics. Conclusions: Based on a small number of low-quality studies, ceftriaxone is as effective as multiple dosing regimes for the treatment of infections due MSSA. An appropriately powered randomized trial is required to demonstrate equivalence and cost effectiveness.
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Pranandari, Rengganis, Sudibyo Supardi, and Retnosari Andrajati. "PARENTERAL ANTIBIOTIC USAGE PATTERNS AND EFFECTS OF INTRAVENOUS TO ORAL SWITCHING ON THE LENGTH AND COST OF HOSPITALIZATION." International Journal of Applied Pharmaceutics 9 (October 30, 2017): 85. http://dx.doi.org/10.22159/ijap.2017.v9s1.44_50.

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Objective: The prolonged use of intravenous antibiotics might increase the length and cost of hospitalization. The research objective, therefore, was toevaluate the effect of switching antibiotics on the length of hospital stay and hospitalization cost. The prospective cohort research design was adopted.The inclusion criteria were in patients who had received intravenous antibiotics.Methods: The sample comprised 39 patients who switched antibiotics as an exposed group and 39 patients who did not switch as an unexposedgroup. The data were collected using the patient medical records and the financial data from the hospital information system. The Mann–Whitney testand Chi-square or Fisher’s exact test was applied in the analysis.Results: The results revealed that the antibiotics most commonly switched were intravenous ceftriaxone (83.3%) and oral cefixime (94.8%). From thefive switching patterns observed, the most common switch was from intravenous ceftriaxone to oral cefixime in patients with acute gastroenteritis.All antibiotics were administered in accordance with the National Formulary (NF) guidelines. Only metronidazole (5 mg/ml dose) was inconsistentwith NF. Switching antibiotics did not impact the length of hospital stay and hospitalization cost; however, comorbidities did have an influence here.Conclusions: Further, switching antibiotics impacted the duration over which intravenous antibiotics were administered and the cost of antibiotics.
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Cogen, Jonathan D., Frankline M. Onchiri, Nicole Mayer Hamblett, Ronald L. Gibson, Wayne J. Morgan, and Margaret Rosenfeld. "Association of Intensity of Antipseudomonal Antibiotic Therapy With Risk of Treatment-Emergent Organisms in Children With Cystic Fibrosis and Newly Acquired Pseudomonas Aeruginosa." Clinical Infectious Diseases 73, no. 6 (March 6, 2021): 987–93. http://dx.doi.org/10.1093/cid/ciab208.

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Abstract Background While Pseudomonas aeruginosa (Pa) eradication regimens have contributed to a decline in Pa prevalence in people with cystic fibrosis (CF), this antibiotic exposure might increase the risk of acquisition of drug-resistant organisms. This study evaluated the association between antipseudomonal antibiotic exposure intensity and acquisition risk of drug-resistant organisms among children with CF and new Pa infection. Methods We utilized data from the Early Pseudomonas Infection Control Clinical Trial (EPIC CT), a randomized controlled trial comparing Pa eradication strategies in children with CF and new Pa. The exposure was the number of weeks of oral or inhaled antipseudomonal antibiotics or ever versus never treatment with intravenous antipseudomonal antibiotics during the 18 months of EPIC CT participation. Primary outcomes were risks of acquisition of several respiratory organisms during 5 years of follow-up after EPIC CT estimated using Cox proportional hazards models separately for each specific organism. Results Among 249 participants, there was no increased acquisition risk of any organism associated with greater inhaled antibiotic exposure. With each additional week of oral antibiotics, there was an increased hazard of Achromobacter xylosoxidans acquisition (HR, 1.24; 95% CI: 1.02–1.50; P = .03). Treatment with intravenous antibiotics was associated with an increased hazard of acquisition of multidrug-resistant Pa (HR, 2.47; 95% CI: 1.28–4.78; P = .01) and MRSA (HR, 1.57; 95% CI: 1.03–2.40; P = .04). Conclusions Results from this study illustrate the importance of making careful antibiotic choices to balance the benefits of antibiotics in people with CF while minimizing risk of acquisition of drug-resistant organisms.
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McMeekin, Nicola, Claudia Geue, Andrew Briggs, Ines Rombach, Ho Kwong Li, Philip Bejon, Martin McNally, Bridget L. Atkins, Jamie Ferguson, and Matthew Scarborough. "Cost-effectiveness of oral versus intravenous antibiotics (OVIVA) in patients with bone and joint infection: evidence from a non-inferiority trial." Wellcome Open Research 4 (July 17, 2019): 108. http://dx.doi.org/10.12688/wellcomeopenres.15314.1.

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Background: Bone and joint infections are becoming increasingly common and are usually treated with surgery and a course of intravenous antibiotics. However, there is no evidence to support the superiority of intravenous therapy and there is a growing body of literature showing that oral therapy is effective in treating these infections.Given this lack of evidence the clinical trial ‘Oral Versus Intravenous Antibiotics’ (OVIVA) was designed to assess the clinical and cost-effectiveness of intravenous versus oral antibiotics for the treatment of bone and joint infections, using a non-inferiority design. Clinical results from the trial indicate that oral antibiotics are non-inferior to intravenous antibiotics. The aim of this paper is to evaluate the cost-effectiveness of intravenous compared to oral antibiotics for treating bone and joint infections, using data from OVIVA. Methods: A cost-utility analysis was carried out, the main economic outcome measure was the quality adjusted life-year, measured using the EQ-5D-3L questionnaire, combined with costs to estimate cost-effectiveness over 12-months follow-up. Results: Results show that costs were significantly lower in the oral arm compared to the intravenous arm, a difference of £2,740 (95% confidence interval £1,488 to £3,992). Results of four sensitivity analyses were consistent with the base-case results. QALYs were marginally higher in the oral arm, however this difference was not statistically significant; -0.007 (95% confidence interval -0.045 to 0.031). Conclusions: Treating patients with bone and joint infections for the first six weeks of therapy with oral antibiotics is both less costly and does not result in detectable differences in quality of life compared to treatment with intravenous antibiotics. Adopting a practice of treating bone and joint infections with oral antibiotics early in the course of therapy could potentially save the UK National Health Service over £17 million annually.
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McMeekin, Nicola, Claudia Geue, Andrew Briggs, Ines Rombach, Ho Kwong Li, Philip Bejon, Martin McNally, Bridget L. Atkins, Jamie Ferguson, and Matthew Scarborough. "Cost-effectiveness of oral versus intravenous antibiotics (OVIVA) in patients with bone and joint infection: evidence from a non-inferiority trial." Wellcome Open Research 4 (November 1, 2019): 108. http://dx.doi.org/10.12688/wellcomeopenres.15314.2.

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Background: Bone and joint infections are becoming increasingly common and are usually treated with surgery and a course of intravenous antibiotics. However, there is no evidence to support the superiority of intravenous therapy and there is a growing body of literature showing that oral therapy is effective in treating these infections.Given this lack of evidence the clinical trial ‘Oral Versus Intravenous Antibiotics’ (OVIVA) was designed to assess the clinical and cost-effectiveness of intravenous versus oral antibiotics for the treatment of bone and joint infections, using a non-inferiority design. Clinical results from the trial indicate that oral antibiotics are non-inferior to intravenous antibiotics. The aim of this paper is to evaluate the cost-effectiveness of intravenous compared to oral antibiotics for treating bone and joint infections, using data from OVIVA. Methods: A cost-utility analysis was carried out, the main economic outcome measure was the quality adjusted life-year, measured using the EQ-5D-3L questionnaire, combined with costs to estimate cost-effectiveness over 12-months follow-up. Results: Results show that costs were significantly lower in the oral arm compared to the intravenous arm, a difference of £2,740 (95% confidence interval £1,488 to £3,992). Results of four sensitivity analyses were consistent with the base-case results. QALYs were marginally higher in the oral arm, however this difference was not statistically significant; -0.007 (95% confidence interval -0.045 to 0.031). Conclusions: Treating patients with bone and joint infections for the first six weeks of therapy with oral antibiotics is both less costly and does not result in detectable differences in quality of life compared to treatment with intravenous antibiotics. Adopting a practice of treating bone and joint infections with oral antibiotics early in the course of therapy could potentially save the UK National Health Service over £17 million annually.
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46

McMeekin, Nicola, Claudia Geue, Andrew Briggs, Ines Rombach, Ho Kwong Li, Philip Bejon, Martin McNally, Bridget L. Atkins, Jamie Ferguson, and Matthew Scarborough. "Cost-effectiveness of oral versus intravenous antibiotics (OVIVA) in patients with bone and joint infection: evidence from a non-inferiority trial." Wellcome Open Research 4 (December 18, 2019): 108. http://dx.doi.org/10.12688/wellcomeopenres.15314.3.

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Background: Bone and joint infections are becoming increasingly common and are usually treated with surgery and a course of intravenous antibiotics. However, there is no evidence to support the superiority of intravenous therapy and there is a growing body of literature showing that oral therapy is effective in treating these infections. Given this lack of evidence the clinical trial ‘Oral Versus Intravenous Antibiotics’ (OVIVA) was designed to assess the clinical and cost-effectiveness of intravenous versus oral antibiotics for the treatment of bone and joint infections, using a non-inferiority design. Clinical results from the trial indicate that oral antibiotics are non-inferior to intravenous antibiotics. The aim of this paper is to evaluate the cost-effectiveness of intravenous compared to oral antibiotics for treating bone and joint infections, using data from OVIVA. Methods: A cost-utility analysis was carried out, the main economic outcome measure was the quality adjusted life-year, measured using the EQ-5D-3L questionnaire, combined with costs to estimate cost-effectiveness over 12-months follow-up. Results: Results show that costs were significantly lower in the oral arm compared to the intravenous arm, a difference of £2,740 (95% confidence interval £1,488 to £3,992). Results of four sensitivity analyses were consistent with the base-case results. QALYs were marginally higher in the oral arm, however this difference was not statistically significant; -0.007 (95% confidence interval -0.045 to 0.031). Conclusions: Treating patients with bone and joint infections for the first six weeks of therapy with oral antibiotics is both less costly and does not result in detectable differences in quality of life compared to treatment with intravenous antibiotics. Adopting a practice of treating bone and joint infections with oral antibiotics early in the course of therapy could potentially save the UK National Health Service over £17 million annually.
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47

McMeekin, Nicola, Claudia Geue, Andrew Briggs, Ines Rombach, Ho Kwong Li, Philip Bejon, Martin McNally, Bridget L. Atkins, Jamie Ferguson, and Matthew Scarborough. "Cost-effectiveness of oral versus intravenous antibiotics (OVIVA) in patients with bone and joint infection: evidence from a non-inferiority trial." Wellcome Open Research 4 (January 8, 2020): 108. http://dx.doi.org/10.12688/wellcomeopenres.15314.4.

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Background: Bone and joint infections are becoming increasingly common and are usually treated with surgery and a course of intravenous antibiotics. However, there is no evidence to support the superiority of intravenous therapy and there is a growing body of literature showing that oral therapy is effective in treating these infections. Given this lack of evidence the clinical trial ‘Oral Versus Intravenous Antibiotics’ (OVIVA) was designed to assess the clinical and cost-effectiveness of intravenous versus oral antibiotics for the treatment of bone and joint infections, using a non-inferiority design. Clinical results from the trial indicate that oral antibiotics are non-inferior to intravenous antibiotics. The aim of this paper is to evaluate the cost-effectiveness of intravenous compared to oral antibiotics for treating bone and joint infections, using data from OVIVA. Methods: A cost-utility analysis was carried out, the main economic outcome measure was the quality adjusted life-year, measured using the EQ-5D-3L questionnaire, combined with costs to estimate cost-effectiveness over 12-months follow-up. Results: Results show that costs were significantly lower in the oral arm compared to the intravenous arm, a difference of £2,740 (95% confidence interval £1,488 to £3,992). Results of four sensitivity analyses were consistent with the base-case results. QALYs were marginally higher in the oral arm, however this difference was not statistically significant; -0.007 (95% confidence interval -0.045 to 0.031). Conclusions: Treating patients with bone and joint infections for the first six weeks of therapy with oral antibiotics is both less costly and does not result in detectable differences in quality of life compared to treatment with intravenous antibiotics. Adopting a practice of treating bone and joint infections with oral antibiotics early in the course of therapy could potentially save the UK National Health Service over £17 million annually.
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48

Sandrowski, Kristin, David Edelman, Michael Rivlin, Christopher Jones, Mark Wang, Gregory Gallant, and Pedro K. Beredjiklian. "A Prospective Evaluation of Adverse Reactions to Single-Dose Intravenous Antibiotic Prophylaxis During Outpatient Hand Surgery." HAND 15, no. 1 (July 15, 2018): 41–44. http://dx.doi.org/10.1177/1558944718787264.

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Background: While it is established that routine prophylactic antibiotics are not needed for all hand surgery, some cases do require it. The purpose of this study was to determine the rate of adverse reactions resulting from prophylactic antibiotic administration on patients undergoing outpatient hand and upper extremity surgical procedures. We hypothesize that the rate of complications resulting from the use of antibiotic prophylaxis is smaller than that reported in the currently referenced literature. Methods: We prospectively evaluated 570 consecutive patients undergoing outpatient upper extremity surgery. Patients were excluded if they were on antibiotics prior to surgery, were discharged on antibiotics, or if they wished to be excluded. Nineteen patients were excluded, resulting in a study cohort of 551 patients. Patients were monitored perioperatively, 2 to 3 days postoperatively, during the first postoperative visit and 1 month postoperatively for adverse reactions. The type and timing of the adverse reaction was recorded. Results: Five hundred fifty-one patients were included for evaluation and 8 patients (1.5%) developed an adverse reaction to antibiotics. Five patients (0.9%) reported a rash and 3 patients (0.5%) reported diarrhea within 3 days of surgery. There were no anaphylactic reactions or complications necessitating hospital transfer or admission in the postoperative period. Conclusion: This study represents a prospective investigation designed to determine the rate of adverse reactions to single-dose antibiotics given during outpatient hand surgery. We conclude that the use of intravenous, single-dose prophylactic antibiotic is safe in the outpatient setting for cases that require it.
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49

Long, Michelle, Deepti N. Reddy, Salwa Akiki, Nicholas J. Barrowman, and Roger Zemek. "Paediatric acute lymphadenitis: Emergency department management and clinical course." Paediatrics & Child Health 25, no. 8 (September 21, 2019): 534–42. http://dx.doi.org/10.1093/pch/pxz125.

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Abstract Objectives To describe clinical characteristics and management of acute lymphadenitis and to identify risk factors for complications. Methods Health record review of children ≤17 years with acute lymphadenitis (≤2 weeks) in a tertiary paediatric emergency department (2009–2014); 10% of charts were reviewed by a blinded second reviewer. Multivariate logistic regression identified factors associated with intravenous antibiotic treatment, unplanned return visits warranting intervention, and surgical drainage. Results Of 1,023 health records, 567 participants with acute lymphadenitis were analyzed. The median age = 4 years (interquartile range [IQR]: 2 to 8 years), and median duration of symptoms = 1.0 day (IQR: 0.5 to 3.0 days). Cervical lymphadenitis was most common. Antibiotics were prescribed in 73.5% of initial visits; 86.9% of participants were discharged home. 29.0% received intravenous antibiotics, 19.3% had unplanned emergency department return visits, and 7.4% underwent surgical drainage. On multivariate analysis, factors associated with intravenous antibiotic use included history of fever (odds ratio [OR]=2.07, 95% confidence interval [CI]: 1.11 to 3.92), size (OR=1.74 per cm, 95% CI: 1.44 to 2.14), age (OR=0.84 per year, 95% CI: 0.76 to 0.92), and prior antibiotic use (OR=4.45, 95% CI: 2.03 to 9.88). The factors associated with unplanned return visit warranting intervention was size (OR=1.30 per cm, 95% CI: 1.06 to 1.59) and age (OR=0.89, 95% CI: 0.80 to 0.97). Factors associated with surgical drainage were age (OR=0.68 per year, 95% CI: 0.53 to 0.83) and size (OR=1.80 per cm, 95% CI: 1.41 to 2.36). Conclusions The vast majority of children with acute lymphadenitis were managed with outpatient oral antibiotics and did not require return emergency department visits or surgical drainage. Larger lymph node size and younger age were associated with increased intravenous antibiotic initiation, unplanned return visits warranting intervention and surgical drainage.
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50

Lin, Jerry W., Ashutosh Kacker, Vijay K. Anand, and Howard Levine. "Catheter- and Antibiotic-Related Complications of Ambulatory Intravenous Antibiotic Therapy for Chronic Refractory Rhinosinusitis." American Journal of Rhinology 19, no. 4 (July 2005): 365–69. http://dx.doi.org/10.1177/194589240501900408.

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Background Chronic rhinosinusitis has several features of a prolonged bacterial infection including positive bacterial cultures and abnormal computed tomography findings such as mucosal thickening and hyperostotic bone. Recent studies have suggested that chronic rhinosinusitis may be treated successfully by outpatient parenteral antibiotic treatment (OPAT). In this setting, antibiotics are administered through a peripherally inserted central catheter (PICC). This study evaluates complications arising from OPAT for chronic rhinosinusitis. Methods A chart review was performed of 177 patients who underwent OPAT for chronic rhinosinusitis. Results PICC line–related infections (4/177, 2%)) included line thrombosis in three patients and septicemia in one patient. In the three patients with line thrombosis, the PICC lines were removed and replaced, allowing for completion of the antibiotic course. Antibiotic complications (29/177, 16%) included four patients with transient neutropenia and one patient with elevated liver function tests. Of the four patients with neutropenia, only one required a change in antibiotics. The patient with elevated liver function tests did not require a change in antibiotics. Minor complications from antimicrobial treatment such as rash, itchiness, flushing, and diarrhea were reported by 25 patients, 9 of these patients required a change in antibiotics. There were no permanent complications or deaths in this study. Conclusion Intravenous antimicrobial treatment administered through a PICC line in an outpatient setting is well-tolerated for chronic rhinosinusitis. Although PICC line and antibioticrelated complications are relatively infrequent, the physician should be aware of these complications and consider them in selecting patients for OPAT.
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