Related Experiment Videos
Use of an ambulatory infusion pump in a 12-year-old with Salmonella osteomyelitis
A J Vaida1, C J Mattiucci, S A Shapiro
1Pharmacy Services, Suburban General Hospital, Norristown, PA 19404.
Insights
Home parenteral antibiotic therapy using an ambulatory infusion pump effectively treated Salmonella osteomyelitis in a pediatric sickle cell hemoglobinopathy patient. This method proved convenient and cost-saving for managing complex infections at home.
Area of Science:
- Pediatric Infectious Diseases
- Hematology
- Pharmacology
Background:
- Sickle cell hemoglobinopathy patients are susceptible to invasive Salmonella infections.
- Osteomyelitis requires prolonged parenteral antibiotic treatment.
- Home therapy offers convenience but requires careful drug administration.
Observation:
- A 12-year-old girl with sickle cell hemoglobinopathy developed Salmonella osteomyelitis.
- The patient required six weeks of parenteral antibiotic therapy.
- An ambulatory infusion pump (Pharmacia-Deltec CADD-VT) was selected for home administration of ampicillin due to frequent dosing and family concerns.
Findings:
- Ampicillin was administered at 1.3 g every six hours, prepared as a 60 mg/mL solution.
- The infusion pump delivered 22 mL/h over one hour every six hours, with a 0.2 mL/h keep-vein-open rate.
- Daily cassette changes by a home therapy nurse ensured medication delivery, leading to successful eradication of osteomyelitis.
Implications:
- Ambulatory infusion pumps are an effective and convenient option for home parenteral antibiotic therapy in pediatric patients.
- This approach can be cost-saving compared to prolonged hospitalization.
- Successful home management of Salmonella osteomyelitis in sickle cell disease patients is feasible with appropriate technology and nursing support.
Abstract:
A 12-year-old girl with sickle cell hemoglobinopathy presented with a Salmonella osteomyelitis of her right humerus requiring six weeks of parenteral antibiotic therapy. Home therapy was evaluated. Due to the frequency of the medication administration (every six hours) and the apprehension of the family members, a Pharmacia-Deltec CADD-VT Infusion Pump was chosen for drug administration. Based on the stability of ampicillin, 1.3 g q6h was administered to provide a minimum of 1 g for the last dose of a 24-hour cycle. Ampicillin 6 g contained in 100 mL of sterile water for injection provided a 60 mg/mL solution with an osmolarity of 347 mOsmol. The pump was programmed to deliver 22 mL of solution over one hour, every six hours. A keep-vein-open rate of 0.2 mL/h maintained line patency. A 100 mL cassette of solution prepared daily was replaced on the pump by a home therapy nurse each morning. At the end of six weeks of therapy, the osteomyelitis was eradicated. We found the use of an ambulatory infusion pump an effective, convenient, and cost-saving method of treatment for our patient.