Subcutaneous antibiotics in palliative medicine: Retrospective chart review

To investigate the use and safety of subcutaneous (SC) antibiotics for infection and symptom control in the palliative setting.

We conducted a retrospective chart review of the use of SC antibiotics since it was introduced to our palliative care service 7 years ago. All records were examined to ascertain therapeutic aim and tolerability.

SC antibiotics were administered to 87 patients (79% had cancer) on 112 occasions (for infection, 105/112, or symptom control, 7/112) in the inpatient hospice or home. 85% wanted to avoid hospitalisation and requested active treatment in situ. Reasons for SC rather than intravenous administration included venous fragility and lack of an available cannulator. Piperacillin/tazobactam was the most common antibiotic given. Of the occasions when treating for infection, the respiratory tract was the most common site; half survived beyond 21 days. Of those used for symptoms, antibiotics appeared helpful in 3/7. Adverse events led to discontinuation in 7/112 (Clostridium difficile, generalised rash or SC site problems in 1, 1 and 5/112, respectively).

SC antibiotics appear well tolerated in the palliative setting and could be a useful option in selected patients who want to avoid hospitalisation but receive active treatment in situ. Thus, we believe that further research is warranted.