Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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Review
The unique issues of outpatient parenteral antimicrobial therapy in children and adolescents.
The decision to discharge a hospitalized child or adolescent to receive outpatient parenteral antimicrobial therapy (OPAT) is based on criteria very different from those concerning adults. Clinical studies of pediatric OPAT are sparse, as are pharmacokinetic data for antimicrobial agents in children. ⋯ The psychological disadvantage of hospitalization in children, compared with adults, is great, and both populations are equally vulnerable to nosocomial infection, increasingly augmented by multidrug-resistant organisms. Although the relatively few clinical studies involving OPAT in children attest to its efficacy and safety, well-designed prospective trials and comprehensive cost-benefit analyses are still needed.
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Booster vaccination against tetanus and diphtheria at 10-year intervals is commonly recommended. Reduced antigen content diphtheria and tetanus toxoids and acellular pertussis (dTpa) vaccines developed for booster vaccination of preschool children, adolescents, and adults are licensed for once-in-a-lifetime use in most countries. Objective. To evaluate decennial administration of a dTpa vaccine. Methods. Young adults vaccinated with dTpa or diphtheria and tetanus toxoids followed by acellular pertussis (DT+ap) 1 month later in a clinical trial 10 years previously received 1 dTpa dose. Blood samples were taken before and 1 month after vaccination. Antibody concentrations against vaccine antigens were measured by enzyme-linked immunosorbent assay. Solicited and unsolicited symptoms and serious adverse events were recorded. ⋯ A second dTpa booster was highly immunogenic and well tolerated in this population of young adults. This study supports the use of this vaccine as a decennial booster.
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Although first identified just >4 decades ago, methicillin-resistant Staphylococcus aureus (MRSA) has undergone rapid evolutionary changes and epidemiologic expansion to become a major cause of nosocomial and community-acquired infections worldwide. Increasing resistance to vancomycin among MRSA strains in conjunction with availability of new antibiotics, including daptomycin and linezolid, have increased treatment choices but made clinical treatment decisions more challenging. This article describes the clinical features and management issues of 2 challenging-to-treat manifestations of MRSA infection, bacteremia and/or endocarditis and osteomyelitis. It also presents a brief review of community-associated MRSA infections and preventive strategies directed against MRSA.
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Since its introduction in the 1970s, outpatient parenteral antimicrobial therapy (OPAT) has become a standard modality for patients with many infections requiring long-term intravenous antibiotic therapy. Delivery of OPAT may occur in physicians' offices, hospital clinics, specialized infusion centers, and currently most often, patient's homes, often self-administered. ⋯ An OPAT Outcomes Registry contains information from >11,000 antibiotic courses administered from 1997 through 2000. Although a number of studies are purported to analyze the economic impact of OPAT on health care, a comprehensive, clinical outcomes-based pharmacoeconomic analysis, as described here, has, to our knowledge, yet to be done.
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Early hospital discharge of acutely infected patients to received outpatient parenteral antimicrobial therapy has been shown to be safe and effective. However, concerns over safety, potential litigation, and anxieties of the patient and family about not receiving professional care have limited the use of this approach. ⋯ Clinical studies have shown that telemedicine is safe and cost-effective, compared with hospital treatment, in chronically ill and acutely infected patients. More studies are needed to further establish the widespread and increasing practice of telemedicine, which may represent the future of medicine.