Antimicrobial therapy in special situations, including extended care facilities and the outpatient setting

After implementation of the diagnosis-related group (DRG) payment system by the federal government there has been a shift of medical care, including intravenous antibiotic therapy, from the acute care hospital to the extended care facility and to the patient's home. Antibiotic selection in the extended care facility involves consideration of a number of factors such as the health status of the patient and the common infections that occur in patients in these facilities, which generally are similar to hospital-acquired infections. Home intravenous therapy is appropriate for treatment of some infectious diseases and is generally safe, although a number of infections and other complications may occur and may require consideration by the physician and the home therapy nurse. Common infectious complications and choices of antibiotic therapy in these two settings are reviewed.