Home‐based treatment of cellulitis with twice‐daily cefazolin

Abstract

Objective To assess the clinical outcome and pharmacokinetics of therapy with cefazolin for patients with cellulitis in a hospital‐in‐the‐home (HIH) program. Design Observational study with outcome data compared with previously published reports of therapy for cellulitis. Setting: A university teaching hospital and HIH unit, July 1996 – December 1997. Participants Patients with cellulitis were eligible for inclusion provided their medical condition was stable, they did not require surgical intervention, and their social circumstances allowed home‐based therapy. Intervention Cefazolin 2g intravenously twice daily, with regular nursing and medical assessment. Main outcome measures Clinical efficacy; peak and trough serum concentrations of cefazolin. Results Fifty‐seven patients (37 were men) with a mean age of 48 years (range, 18–90 years) had 61 episodes of moderate to severe cellulitis (41, lower limb; 17, upper limb; and three, face). They received a median of 11 doses of cefazolin (range, 3–27 doses). Clinical outcomes were: cure in 54, improvement in one, treatment failure in three, and in the remaining three episodes the outcome was indeterminate. Cefazolin concentrations were measured in 27 patients. All peak concentrations were more than 40μg/mL, while trough concentrations were all above the MIC90 of the expected pathogens: median, 3.2μg/mL (range: 0.4–18.5 μg/mL). Cefazolin was well tolerated. Conclusions Twice‐daily cefazolin 2g intravenously is a convenient and effective option for home‐based treatment of patients with cellulitis. Its clinical efficacy is comparable with other treatment regimens.

Randomised controlled trial of intravenous antibiotic treatment for cellulitis at home compared with hospital

“…Overall, the patients treated at home spent 10.1 days in the programme, whereas the hospital patients stayed in hospital 7.4 days. Three other studies from Australia have described the results of intravenous treatment of cellulitis at home 3 4 11. Patients in these studies all needed 5.5-6.5 days of intravenous treatment at home.…”

Outpatient Parenteral Antimicrobial Therapy Practices among Adult Infectious Disease Physicians

“…Over the past 30 years, outpatient parenteral antimicrobial therapy (OPAT) has gained in popularity as a cost-effective strategy for treating a variety of infectious diseases including skin and soft tissue infections 1, 2 , osteomyelitis 3, 4 , prosthetic joint infections 5 6 , and endocarditis 7 . In a 2006 survey of infectious disease physicians, 94% indicated that patients are commonly set up for OPAT at hospital discharge.…”

Cost analysis of a hospital-at-home initiative using discrete event simulation

“…The concept of hospital-at-home, which originated as 'hospitalisation à domicile' in France and is now used internationally to treat patients with a variety of conditions in their home environments, [3][4][5][6][7][8][9] was taken up, as a 'winter pressures' initiative, by Hillingdon Health Authority in West London. In November 1997, the health authority commissioned Hillingdon Hospital NHS Trust with the London Borough of Hillingdon Social Services Department, and Harrow and Hillingdon Healthcare NHS Trust, to provide a rapid response hospital-at-home service.…”