Home intravenous antibiotics
Hospital In The Home (HITH)
New and existing referrals
Contact the HITH Registrar (via QCH switchboard) or the CHQatHome Care Coordinator at the Queensland Children’s Hospital (QCH) on 0432 003 030.
HITH referrals
- Referrals to HITH are made via phone call to the HITH Registrar (contact via QCH Switchboard (07) 3068 1111).
- All home parenteral antimicrobial therapy requires Infectious Diseases Approval prior to making (HITH) referral for all indications, excluding the following:
- CF patients receiving Tobramycin and Piperacillin/Tazobactam or Ceftazidime for (HITH) according to the CHQ-GDL-01073 Empirical antimicrobial therapy for children with Cystic Fibrosis
- Non-CF bronchiectasis patients receiving Ceftriaxone according to the CHQ-GDL-01072 Empirical antimicrobial therapy for children with Non-Cystic Fibrosis Bronchiectasis
- For the following indications according to the CHQ-GDL-63012 CHQ Hospital in the Home antibiotic guidelines in infants (>3 months of age) and children deemed to be unsuitable for oral antimicrobial therapy:
- Community acquired pneumonia (not tolerating oral therapy)
- Cellulitis
- Lymphadenitis
- Pre-septal/peri-orbital cellulitis
- Urinary tract infections
- see QCH Antimicrobial Formulary.
- Written confirmation of Infectious Diseases approval needs to be documented in ieMR.
CHQ At Home documents (QH staff only)
- Hospital In The Home: Referral Flow Sheet
- HITH Program Eligibility: Quick reference guide
- CHQ At Home manual
- CHQ At Home Outpatient Parenteral Antimicrobial Therapy Prescribing, Administration and monitoring guideline
- CHQ-GDL-63012 CHQ Hospital in the Home antibiotic guidelines
- Elastomeric Infusor Device Infusion Record
- Nursing Standard: Elastomeric Infusor Devices
- Continuous IV infusion administration via ambIT pumps for HITH
- Ceftazidime Intermate™ Device medicines fact sheet
Other documents:
For information on the suitability of specific antimicrobials for home intravenous use are listed in the table below. Please contact the HITH/CHQatHome Pharmacist for advice on parenteral antimicrobial suitability for HITH: 0437 976 230.
Optimal conditions for delivering antimicrobial therapy for HITH
Factors you should consider when delivering antimicrobial therapy within a home environment are:
- safety
- drug stability
- ambient temperature
- type of intravenous access
- administration device (springfusor and/or elastomeric device).
Consult the ID team (page via QCH switchboard) for advice on HITH antimicrobial choice and duration of therapy.
Contact your CHQatHome Pharmacist (0437 976 230) for advice on drug stability and suitable administration device/method.
Paediatric dosing information
For more information on paediatric dosing, administration and monitoring of HITH antimicrobial therapy, refer to:
- CHQ At Home Outpatient Parenteral Antimicrobial Therapy Prescribing, Administration and monitoring guideline (QH staff only).
| Antimicrobials | HITH suitability , suggested IV dosing schedule and type of IV access required |
|---|---|
| Aciclovir | Not suitable for HITH - seek ID team and pharmacist advice. PICC line or CVAD required. Not suitable for administration via PIVC. |
| Amikacin | Suitable for HITH Administer once daily (infuse over 30minutes) Seek ID team and pharmacist advice on dosing and therapeutic drug monitoring. Peripheral IV cannula (PIVC) or CVAD. Note: For HITH treatment >7days, PICC line , Midline or CVAD required. |
| Ampicillin | Not suitable for HITH. Not stable at room temperature as 24-hour continuous infusion. Seek ID team advice for alternative treatment option. |
| Amoxycillin | Not suitable for HITH. Not stable at room temperature as 24-hour continuous infusion. Seek ID team advice for alternative treatment option. |
| Amoxycillin/Clavulanate | Not suitable for HITH. Not stable at room temperature as 24-hour continuous infusion Seek ID team advice for alternative treatment option. |
| Amphotericin (liposomal) | Seek ID team and pharmacist advice. Administer once daily (infuse over 60minutes or longer) PICC line or CVAD required. Not suitable for administration via Midline. |
| Anidulafungin | Suitable for HITH. Once daily (infuse over 60 minutes or longer – max infusion rate of 1.1mg/minute) Peripheral IV cannula (PIVC) or CVAD. Note: For HITH treatment >7days, PICC line or CVAD required. |
| Azithromycin | Not suitable for HITH. Seek ID team advice for alternative treatment option. |
| Aztreonam | Suitable for HITH. 24-hour continuous infusion HITH options:
|
| Benzylpenicillin (with citrate buffer) | Suitable for HITH. 24-hour continuous infusion HITH options:
|
| Caspofungin | Suitable for HITH. Administer once daily (infused over 1 hour) Seek ID team and pharmacist advice. PICC line or CVAD required. Not suitable for administration via PIVC. |
| Cefepime | HITH options: Summer (temperatures exceeding 24 degrees Celsius):
Winter (temperatures consistently below 24 degrees celcius):
|
| Cefotaxime | Not suitable for HITH. Not stable at room temperature as 24-hour continuous infusion Seek ID team advice for alternative treatment option (for example: Ceftriaxone) |
| Cefoxitin | Suitable for HITH. 24-hour continuous infusion HITH options:
|
| Ceftazidime | Suitable for HITH. Administered as 8-hourly dosing – each dose administered over 30 minutes via Intermate® ambulatory device. Not stable as continuous infusion. Doses administered by parent/carer after successful completion of CHQ competency training package “Guide to giving your child’s IV antibiotic at home – for children with PICC lines” PICC line or CVAD required. Not suitable for administration via PIVC. |
| Ceftriaxone | Suitable for HITH. Once daily (infuse over 30minutes) Peripheral IV cannula (PIVC) or CVAD. Note: For HITH treatment >7days, PICC line, Midline or CVAD required. |
| Cephazolin (Cefazolin) | Suitable for HITH. 24-hour continuous infusion HITH options:
|
| Ertapenem | Suitable for HITH. Seek ID team advice on appropriate dosing regimen. HITH options: For children under 12 years of age:
For children over 12 years of age:
Peripheral IV cannula (PIVC) or CVAD. Note: For HITH treatment >7days, PICC line, Midline or CVAD required. |
| Flucloxacillin (with citrate buffer) | Suitable for HITH. 24-hour continuous infusion HITH options:
Risk of thrombophlebitis if administered via PIVC or Midline. |
| Foscarnet | Suitable for HITH 24-hour continuous infusion HITH options:
|
| Ganciclovir | Seek ID team and pharmacist advice. CYTOTOXIC agent. PICC line or CVAD required. Not suitable for administration via PIVC or Midline. |
| Gentamicin | Suitable for HITH. Once daily (infuse over 30minutes via springfusor). Seek ID team and pharmacist advice on dosing and therapeutic drug monitoring. Peripheral IV cannula (PIVC) or CVAD. Note: For HITH treatment >7days, PICC line, Midline or CVAD required. |
| Imipenem-cilastatin | Not suitable for HITH. Not stable at room temperature as 24-hour continuous infusion Seek ID team advice for alternative treatment option. |
| Lincomycin | Not suitable for HITH. Seek ID team advice for alternative treatment option. (No current stability data for continuous infusion in elastomeric device) |
| Meropenem | Not suitable for HITH. Not stable at room temperature as 24-hour continuous infusion Seek ID consultant/fellow advice for alternative treatment option. |
| Micafungin | Suitable for HITH. Once daily (infuse over at least 60 minutes) PICC line or CVAD required. |
| Piperacillin/Tazobactam | Suitable for HITH. 24-hour continuous infusion HITH options:
Not suitable for administration via PIVC. |
| Teicoplanin | Suitable for HITH. Once daily (infuse over 5 to 30minutes). Peripheral IV cannula (PIVC) or CVAD. Note: For HITH treatment >7days, PICC line, Midline or CVAD required. |
| Tobramycin | Suitable for HITH. Administer once daily (infuse over 30minutes). Seek ID team and pharmacist advice on dosing and therapeutic drug monitoring. Peripheral IV cannula (PIVC) or CVAD. Note: For HITH treatment >7days, PICC line, Midline or CVAD required. |
| Vancomycin | Suitable for HITH. 24-hour continuous infusion HITH options:
Seek ID team and pharmacist advice on dosing and therapeutic drug monitoring. Not suitable for administration via PIVC or Midline. |
| Voriconazole | Not suitable for HITH. Seek ID team advice for alternative treatment option. (No current stability data for continuous infusion in elastomeric device) |
| Intravenous medication | Dosage |
|---|---|
| Sodium Chloride 0.9% flush | 5-10 mL IV PRN |
| Long term heparin lock (>24hours) (Caution: Not to be used for haemophilia patients) | Dilute 1mL of 1000 units/mL Heparin with 9mL Sodium Chloride 0.9%. (final concentration of 100units/mL heparin) Use 1 to 2mL** IV PRN as along term heparin lock (volume is dependent on type of device - see table 1 below) |
| Cetirizine (Zyrtec) (in the event of allergic reaction) | Chart as PRN order 1 to 2 years of age 0.25 mg/kg/dose (up to 2.5mg/dose), twice daily PO 2 to 5 years of age 5 mg, daily PO (can divide into 2 doses) 6 to 12 years of age 10 mg, daily PO (can divide into 2 doses) |
| Adrenaline (Epipen®) (Intramuscular Injection) (in the event of anaphylaxis) | Chart as a once only PRN order If less than 20 kg: Give 150 microgram as intramuscular injection If more than 20 kg: Give 300 microgram as intramuscular injection NB. Quantify indications for administration under order |
| Source: | CHQ Procedure: Allergic Reaction Emergency Management in Children CHQ-PROC-01039 Medication – Administration |
| Device | Approximate volume of lumen |
|---|---|
| Tunnelled Cuffed Central Venous Catheter | 2mL |
| Peripherally inserted central venous catheter (PICC) | 1mL |
| Totally implantable Venous port Device | 2mL |
| Source: | CHQ Procedure 03450: CHQ-WI-03457 Central Venous Access Device (CVAD) - Patency, Flushing and Locking (QH staff only). |
Other HITH interventions include:
- Naso-gastric tube management
- Subcutaneous medication (e.g. G-CSF)
- Skin/wound/eczema care/dressings
- Physiotherapy
- Diabetes education/management
- Respiratory/cardiac assessments
- Oximetry
- Hydration assessments, rehydration and others.
- Jaundice
HITH key contacts:
- HITH Registrar contact via QCH Switchboard (07) 3068 1111
- CHQatHome Coordinator 0432 003 030
- CHQatHome Pharmacist 0437 976 230
