Outpatient parenteral antimicrobial-drug therapy

Outpatient parenteral antimicrobial-drug therapy exemplifies the change in focus from inpatient to ambulatory care. Treatment teams have available a bewildering number of new and modified catheters and infusion devices. However, there is a noticeable absence of published controlled studies comparing the old and the new. Even without controlled studies, it is clear that the incidence of phlebitis and infection with current peripherally inserted, tunneled, and implanted central catheters is very low, as compared with historical experience with stiff non-Silastic 'long-arm' central venous catheters, subclavian central-venous-pressure catheters, and other similar but now-discarded intravenous-access devices. Increasingly, the infusion pumps are electronic marvels that, although expensive, allow patients to resume almost completely the activities of daily living. There is need for more study of drug stability under the conditions of use imposed by the various infusion devices. We anticipate that new devices, infusion systems, and infection-control methods will expand the uses and value of outpatient parenteral antimicrobial-drug therapy.