When and How to Use Subcutaneous Antibiotics.

Area of Science:

• Infectious Diseases
• Clinical Pharmacology
• Nursing

Background:

• Subcutaneous (SC) antibiotic administration is an emerging alternative to intravenous (IV) therapy.
• It is beneficial for patients with poor venous access, frail individuals, and in outpatient or palliative settings.
• Oral administration is not always feasible, necessitating alternative routes.

Purpose of the Study:

• To review the clinical experience, pharmacokinetic/pharmacodynamic (PK/PD) data, and technical aspects of SC antibiotic infusion.
• To evaluate the efficacy and tolerability of SC antibiotics compared to IV administration.
• To provide guidance for healthcare professionals on utilizing SC antibiotic therapy.

Main Methods:

• Multidisciplinary review of current clinical experience.
• Analysis of available pharmacokinetic/pharmacodynamic (PK/PD) data for various antibiotic classes.
• Summary of technical considerations for SC infusion.

Main Results:

• SC delivery of time-dependent antibiotics (e.g., beta-lactams, glycopeptides) achieves therapeutic PK/PD targets comparable to IV administration.
• SC daptomycin shows favorable exposure and target attainment with good tolerability.
• Limited PK/PD benefits for concentration-dependent antibiotics (e.g., aminoglycosides, fluoroquinolones) due to reduced peak levels and potential local toxicity.

Conclusions:

• Subcutaneous antibiotic infusion is a safe and effective alternative route for specific antibiotics and patient populations.
• It offers comparable therapeutic outcomes to IV therapy for certain drug classes, with improved patient convenience and reduced complications.
• Further research and regulatory frameworks are needed to expand the use of SC antibiotic administration.