Education And Debate

Intravenous antimicrobial therapy in the community: underused, inadequately resourced, or irrelevant to health care in Britain?

BMJ 1996; 313 doi: (Published 14 December 1996) Cite this as: BMJ 1996;313:1541
  1. Dilip Nathwani, consultant physiciana,
  2. Peter Davey, reader in clinical pharmacology and infectious diseasesb
  1. a Infection and Immunodeficiency Service, King's Cross Hospital, Dundee DD3 8EA
  2. b Medicines Monitoring Unit, Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee DD19SY
  • Accepted 26 August 1996

The NHS Executive is keen to promote “hospital at home” services in Britain, as part of its philosophy of keeping more care in the community and also to relieve the increasing demand for hospital beds. One such service is the provision of intravenous antimicrobial therapy in the community. Yet, compared with the United States, where home or outpatient intravenous antimicrobial therapy programmes are well developed, experience in Britain and Europe is limited, reflecting a difference in cultural attitudes and healthcare structures between the two continents. Only a few units in Britain currently run home intravenous antimicrobial therapy programmes, and several issues need to be addressed if more treatment is to be provided outside hospital. These include an assessment of the need for community intravenous antibiotic treatment and which patient groups many benefit. The main motive for community intravenous treatment should be better patient care and not simply a reduction in healthcare costs. At present the pace of change is being set by a few clinical enthusiasts and by commercial organisations, whereas the NHS deserves a more organised strategy for purchasing treatment with intravenous antibiotics in the community.

Following the development of the Rochester needle by Dr Thomas Massa in 1950 intravenous administration of fluids, drugs, and nutrients became common in hospitals. Over 20 years passed before the first report of community based intravenous treatment—of 13 patients with osteomyelitis.1 Further experience documented substantial financial savings to the hospital from community intravenous therapy,2 3 4 making it popular with third party payers.5 However, patients also benefited through shorter stays in hospital,6 a consequent reduction in the incidence of hospital acquired infections,7 and improvement in quality of life.5 Practical problems can be solved by selecting drugs which need to be administered only once daily,8 such as …

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