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Out of hospital treatment of patients with melioidosis using ceftazidime in 24 h elastomeric infusors, via peripherally inserted central catheters.

AbstractBACKGROUND:
In the tropical north of the Northern Territory, Australia, 25-50 patients are admitted to Royal Darwin Hospital (RDH) each year with Burkholderia pseudomallei infection, or melioidosis. Treatment consists of initial intensive therapy with 2-4 weeks of intravenous antibiotics. Clinical improvement may occur early and patients often prefer to be managed out of hospital in the Hospital in the Home (HITH).
OBJECTIVES:
To evaluate safety and efficacy of HITH management of patients with melioidosis.
METHODS:
A prospective observational study of our standard management which consists of 24 h infusions of ceftazidime infused through a peripherally inserted central catheter (PICC) line, plus oral sulphamethoxazole trimethoprim. Treatment is administered in the home, which may be in Darwin, regional areas or remote communities, or in a self-care unit located in the hospital grounds.
RESULTS:
From February 1998 to December 2001 150 patients were admitted to RDH with culture confirmed B. pseudomallei infection. Of these, 73 patients were treated with 24 h infusions of ceftazidime, of which 70 patients were managed by HITH. Complications of treatment include a PICC line complication rate of 10.6/1000 days in situ. Nine patients had relapse or recrudescence of disease, nearly all as a result of poor adherence to subsequent oral eradication therapy, these patients were all re-treated successfully. One patient remains infected with B. pseudomallei.
CONCLUSION:
This clinical outcome study suggests that out of hospital management of melioidosis with 24 h infusions of ceftazidime via a PICC line is safe and effective.
AuthorsSarah Huffam, Susan P Jacups, Paulene Kittler, Bart J Currie
JournalTropical medicine & international health : TM & IH (Trop Med Int Health) Vol. 9 Issue 6 Pg. 715-7 (Jun 2004) ISSN: 1360-2276 [Print] England
PMID15189462 (Publication Type: Journal Article)
Chemical References
  • Anti-Bacterial Agents
  • Ceftazidime
Topics
  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents (administration & dosage)
  • Catheterization, Central Venous (methods)
  • Ceftazidime (administration & dosage)
  • Child
  • Child, Preschool
  • Equipment Failure
  • Female
  • Home Infusion Therapy
  • Humans
  • Infusions, Parenteral (methods)
  • Male
  • Melioidosis (drug therapy)
  • Middle Aged
  • Northern Territory
  • Patient Compliance
  • Prospective Studies
  • Recurrence
  • Treatment Outcome

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