Customize your JAMA Network experience by selecting one or more topics from the list below.
When serious infections require intravenous antibiotics for weeks rather than days, many patients can receive treatment at home.
Patients with serious infections who need intravenous (IV) antibiotics but who otherwise feel well and don’t have any other reason to be in the hospital may qualify for home IV antibiotic therapy. Patients are often surprised to learn that with some basic education and support from their clinicians, they or a family member can administer IV antibiotics at home.
Other options for IV antibiotic therapy outside the hospital include daily visits to an outpatient infusion center or admission to a skilled nursing facility. The choice depends on insurance coverage and patient preferences—not every patient is comfortable administering their own IV antibiotics or has family or friends who can help.
Home Administration of IV Antibiotics
When long courses of IV antibiotics are given outside the hospital, they are administered through a small tube called a catheter placed in a large vein, usually on the inside of the upper arm. A sterile protective dressing is placed over the catheter insertion site. Catheter care includes weekly dressing changes by a nurse, keeping the dressing clean and dry, protecting the insertion site from trauma, and avoiding heavy lifting. Aside from these precautions, the catheter generally does not affect daily activities.
Patients receiving home IV antibiotics work with multiple clinicians, including the doctor who prescribes the antibiotic (usually an infectious disease specialist); nurses who work in the prescribing doctor’s office, sometimes called infusion nurses; pharmacists from the home infusion company who arrange delivery of the IV antibiotics; home health nurses (if covered by the patient’s insurance); and a surgeon (depending on the type of infection).
How It Works
A home health nurse makes an initial home visit to teach the patient and/or family members to administer the IV antibiotic. Most patients need 1 to 3 antibiotic doses a day for 1 to 8 weeks. The nurse visits at least once a week to change the catheter dressing and take blood samples. The prescribing doctor monitors the results of the weekly blood tests and usually sees the patient in the clinic once or twice during treatment. Patients should notify their doctor of new symptoms. When the planned antibiotic course is complete and the prescribing doctor has confirmed that the IV antibiotic can be stopped, the catheter can be removed at home by the nurse or in the clinic. Sometimes insurance doesn’t cover home nursing care, so education, blood draws, and dressing changes are done in the clinic.
Side Effects and Risks
The most common side effects associated with antibiotics include rash, itch, diarrhea, and abnormal kidney or liver laboratory test results. The prescribing doctor monitors for these side effects and adjusts the antibiotic when necessary.
The most common risks associated with intravenous catheters include blockages, blood clots, and infection. Patients need to contact their nurse or doctor if they notice any swelling, pain, or redness in the arm with the catheter.
Conflict of Interest Disclosures: None reported.
Source: Norris AH, Shrestha NK, Allison GM, et al. 2018 Infectious Diseases Society of America clinical practice guideline for the management of outpatient parenteral antimicrobial therapy. Clin Infect Dis. 2019;68(1):e1-e35. doi:10.1093/cid/ciy745
Grennan D, Gottsch M. Home Intravenous Antibiotic Therapy. JAMA. 2019;322(1):90. doi:10.1001/jama.2019.7424
Monkeypox Resource Center