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Teicoplanin in home therapy of the terminally ill child
L M Ball1, S Siddal, H van Saenen
1Department of Clinical Haematology, Royal Liverpool Children's Hospital, UK.
Insights
Parents can effectively treat central venous line infections at home using teicoplanin, improving quality of life for children with serious illnesses. This approach avoids hospitalizations and offers significant benefits for family relationships.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Central venous lines are crucial for treating critically ill children but pose infection risks.
- Managing line infections in terminally ill children often requires hospitalization, impacting family dynamics.
- Antibiotic therapy for line infections needs careful consideration in palliative care settings.
Purpose of the Study:
- To evaluate the efficacy and safety of home-based teicoplanin treatment for central venous line infections in pediatric patients.
- To assess the feasibility of parental instruction and home administration of antibiotics for line infections.
- To determine the impact of home treatment on patient quality of life and parent-child relationships.
Main Methods:
- A cohort of five pediatric patients with central venous line infections was selected for home treatment.
- Parents received instruction for administering teicoplanin at home.
- Treatment success was defined by resolution of infection without hospital admission or adverse events.
Main Results:
- All five children completed 7-day teicoplanin treatment courses at home.
- Infections occurred a mean of 3.2 weeks post-discharge and were successfully treated without hospital readmission.
- No deaths were attributed to antibiotic failure, and no significant side-effects were reported.
Conclusions:
- Home-based teicoplanin treatment for central venous line infections is effective and well-tolerated in pediatric palliative care.
- This approach enhances quality of life and strengthens parent-child bonds during terminal illness.
- Parental education enables successful home management of line infections, reducing healthcare burden.
Abstract:
Children discharged in the terminal phase of illness were offered the possibility of having central venous line infections treated with teicoplanin at home by their parents after suitable instruction. The decision to begin antibiotic treatment was subjective, based on a history of rigors and/or raised temperature in an otherwise "well" child. No difficulties were encountered in instructing the chosen parents. In all, five treatment periods of 7 days were required in the five children selected. The review time was 31 weeks (mean duration, 6.2 weeks/patient; range, 4-12 weeks), ended in all cases by death. Infection occurred a mean of 3.2 weeks after discharge (range, 1-8 weeks), and all episodes were successfully treated at home without hospital admission or ward-based support. No deaths occurred as a result of antibiotic therapy failure, and there were no clinically relevant side-effects. Autopsy confirmed the absence of central venous line infection in one patient, but blood culture was positive for Staphylococcus aureus in another. This study shows that home treatment of line infections with teicoplanin is effective and well tolerated, and offers advantages in terms of quality of life and parent-child relationships.