Anaphylaxis Kits for Home IV, is there a need?
Submitted by Jane Macfarlane, District Nurse NMDHB. Originally printed in December 2006 IVNNZ Inc. Newsletter
Home intravenous antibiotic therapy and allergic drug reactions; is there a case for routine supply of anaphylaxis kits?
This concern has been voiced previously by District Nurses in several areas around the country. We are interested in what policies other DHB ‘s have in place for the management of the potential [although very rare] anaphylaxis.
We experienced at Wairau Hospital, Blenheim, in May 2006 a severe anaphylaxis reaction to the administration of intravenous Amoxil first dose. Fortunately this dose was being administered in the Emergency Department as per protocol. The male patient was 69 years of age and was referred for IV antibiotic cover by the dental team. The client had no previous allergy to penicillins. He suffered anaphylactic reaction five minutes post dose. His symptoms were complete apnoea and loss of consciousness. He required IV adrenalin, hydrocortisone and an adrenalin infusion. He was transferred to ICU over night and then discharged home the next day. Had this dose been given in a community setting the patient would likely have died. This is a concern for staff who administer I.V. AB's in the community.
An abstract from an article published in the Journal of Infusion Nursing, 27 [ 6 ] : 425 - 430, 2004, Nov / Dec. By Dobson, Boyle and Loewenthal states ‘In this study, 770 patients received a 1000 courses of home intravenous therapy with 25 different antibiotics for 37 conditions.
The patients in the program experienced 28 allergic reactions. The mean time for allergic reaction was 19.6 days. No episodes of anaphylaxis were observed. These results coupled with the potential disadvantages of issuing epinephrine to all patients receiving home antibiotic therapy suggest this strategy may not provide a nett benefit.'
The B.M.J. (16 Dec 2004) published an article focused on intravenous antibiotic therapy. It was a prospective randomised control trial in Christchurch New Zealand of 200 patients from July 2002 to June 2003. Cellulitis is an acute bacterial infection of the skin and subcutaneous tissue. It is a common condition that often requires treatment with intravenous antibiotics. All the participants of this study were treated for cellulitis. It concluded that ‘Intravenous antibiotic treatment can be delivered safely and effectively in patients homes'.
In this article no anaphylaxis was recorded.
The New Zealand Medical Journal vol 117 no. 1200 ISSN 1175 8716.
Published an article by Upton, Ellis -Pegler, Woodhouse. This article reviewed Auckland Hospital Outpatient Parental Antimicrobial Therapy Service.
It looked at 100 patients over a 20 month period who were treated with 107 courses of outpatient IV antibiotic therapy. Bone and joint infections accounted for nearly 60% of the referrals. Antibiotics prescribed were narrow spectrum and patients self administered up to four times daily. They concluded ‘that parental antibiotic therapy can be administered safely and successfully in an outpatients setting despite relatively frequent dosing intervals. The majority of complications were minor and 88% of patients were cured.'
No anaphylaxis reactions were recorded.
There is limited data to support any indication that home I.V therapy has an unacceptable risk of anaphylaxis. This is an issue that was recently discussed at the IVNNZ IV Nurses Forum held in Wellington and further discussion is warranted.