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5: Hospital-in-the-home treatment of infectious diseases

Benjamin P Howden and M Lindsay Grayson, Series Editors:
Med J Aust 2002; 176 (7): 440-445.

Summary

  • A growing range of infections can be safely and effectively treated with parenteral antimicrobial therapy at home, including cellulitis, pyelonephritis, pneumonia, endocarditis, osteomyelitis, septic arthritis and deep abscesses.

  • Patients may be admitted to HITH directly from the emergency department or after a period of in-hospital care; they must be thoroughly assessed for suitability, including clinical stability and social circumstances, and both patient and carer consent must be obtained.

  • Patients should be medically reviewed weekly at the hospital to monitor progress of therapy and check for possible complications, including adverse drug reactions.

  • Antibiotic selection should be based on appropriate prescribing principles rather than purely dosing convenience.

  • Innovative dosing regimens, including once-daily aminoglycosides, continuous-infusion β-lactams (eg, flucloxacillin), once- or twice-daily cephalosporins (eg, cephazolin) and oral fluoroquinolones (eg, ciprofloxacin) provide effective therapy for a wide range of infections that would have previously required in-hospital care.

  • Appropriate use of HITH leads to improved patient and carer satisfaction, efficient in-hospital bed use and possibly some financial efficiencies.

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  • Benjamin P Howden1
  • M Lindsay Grayson2
  • Series Editors:

  • Austin and Repatriation Medical Centre, Melbourne, VIC.


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