Feasibility and cost savings of intravenous administration of aminoglycosides in outpatients with cystic fibrosis

Hospitalization for some patients is often prolonged by days to weeks to complete a course of intravenous antibiotics. This is true with CF patients' who usually receive aminoglycosides throughout their hospital course. This study assesses the practicality and cost effectiveness of intravenous aminoglycoside therapy in outpatients with CF. Fifteen patients were discharged from the hospital a total of 31 times with up to three days of antibiotic, preloaded in syringes, to be administered with a portable syringe pump that delivered a dose over 40 minutes. A total of 242 drug infusions were self-administered in this manner. Flow-rate data indicated that the pumps infused at a rate within +/- 8% of their nominal rate. During the 31 courses of treatment, intravenous catheters had to be replaced on 11 occasions, but four of these episodes occurred in one patient who was treated at home for 36 days. Two malfunctions of the infusion system occurred, as did six catheter site reactions. The cost of preparing drug doses for outpatient use of this system and rental of the pump is not only less than that for in-hospital administration with piggy-back bottles (approximately $20 vs. $30/d, respectively), but totally negates the cost of the hospital room (approximately $200/d). Outpatient administration of aminoglycoside by controlled intravenous infusion is not only convenient and safe, but results in considerable cost savings.