Non-inpatient parenteral antibiotic therapy in febrile adults

Non-inpatient care is becoming an increasingly attractive option in many therapeutic areas, including the treatment of infections in patients with haematological malignancies. The choice of antibiotics for this care is governed by infection patterns and experience within particular institutions. There is an increase in infections caused by Gram-positive pathogens due to the long-term use of tunnelled catheters and intensive, punishing chemotherapy regimens. Patients suitable for non-inpatient care include both long- and short-term patients who fulfil specific clinical and social criteria. Haematological malignancy patients are often suitable for this type of care. Benefits for patients include improved quality of life, while benefits for the clinician include effective, safe care as well as reduced costs and greater bed availability. The glycopeptide teicoplanin has been assessed for use in non-inpatient care, and is particularly suitable due to its long half-life, no need for monitoring and its activity against Gram-positive pathogens. A comparative study of a teicoplanin-ciprofloxacin combination was conducted in inpatients, followed by a cohort study in non-inpatients. This combination was found to be clinically and microbiologically effective, suitable for non-inpatient administration and generated cost savings due to early discharge. The organization of a non-inpatient service demands dedicated team members, with well-defined roles and a designated treatment area. The day ward is the focus of care, which can then take place in the day ward or in the patient's home. Good communication between immediate and wider team members, and patient education are cornerstones of a successful service.