Experience with teicoplanin in non-inpatient therapy in children with central line infections

Indwelling intravenous catheters are an invaluable part of the curative therapy or terminal care of children with haematological malignancies. The increase in their use has been paralleled by an increase in Gram-positive infections, however. This article provides an overview of non-inpatient treatment of central line infections using teicoplanin. The main drivers for considering non-inpatient therapy were to increase the quality of the patient's life by reducing the amount of time spent in hospital, and to prolong the life of the catheter. A large proportion (95%) of the children in the unit described have indwelling catheters in situ, including Port-a-caths, Hickman catheters and Vascaths. The indications suitable for non-inpatient antibiotic therapy of line infections were those patients near the end of their chemotherapy courses, during terminal care, in non-neutropenic patients to complete an antibiotic course, and in patients with chronically neutropenic aplastic anaemia. Persistent line infections are not always eradicated but usually controlled. Care can take place in the home, in the general practitioner (GP) surgery or in the outpatient clinic. Care can be undertaken by nurses, older patients and parents. Follow-up procedures are in place to ensure safe, effective therapy.