The therapy of osteomyelitis in outpatient settings

Because of rising hospital costs, the use of outpatient antibiotic therapy, both oral and parenteral, is increasing. A program for the intravenous administration of antibiotics to outpatients has been established as a freestanding outpatient clinic (Intracare). Some diseases lend themselves to treatment in such a setting better than others. Osteomyelitis accounted for one-third of the diagnoses in the first 1,000 patients treated at Intracare. While patients are usually begun on intravenous antibiotics following initial surgical debridement in the hospital, hospitalization may be avoided entirely in some patients who undergo surgery in outpatient surgical centers and are begun on intravenous antibiotics immediately afterwards at Intracare. For outpatient use, cephalosporins are most frequently used because of their efficacy, safety, and pharmacokinetics, which allows less-frequent administration. Both cefazolin and ceftriaxone were used most frequently in the Intracare program, although the once-daily administration of ceftriaxone was considered most convenient for outpatients and allowed them to return to normal activities even while receiving antibiotic therapy.