The problems of treatment
Antibiotic treatment is the globally accepted standard and delayed
treatment has clearly identifiable complications (1)(17)(18). However,
we are not aware of any current evidence on the complications of
intravenous antibiotics in the NOE patient cohort.
It is well recognised that antibiotic use is associated with allergy,
intolerance and adverse effects. Adverse events in short-term antibiotic
use in hospitalised patients is as high as 20% with an increasing risk
for every additional 10 days of use (19)(20). Prolonged use of tazocin
is an independent risk factor for leukopenia and neutropenia; occurring
in 10-16% of cases (21). A large multi-centre study comparing tazocin
and ceftazidime has shown that kidney injury, diarrhoea and rash occur
with similar frequency (18-20% risk cumulatively) (22).
However, this paper adds evidence specific to treatment within NOE
patients. It shows that in complex patients with concomitant medical
issues who will be on a prolonged course of treatment, these known
adverse effects occur at a high rate. Uniquely, we have found the rate
of alteration of treatment secondary to adverse effects to be remarkably
high.
To our knowledge, we show the first study of antibiotic use in NOE, and
we demonstrate that in these prolonged courses of antibiotics (mean
>60 days) adverse effects are more common than in shorter
courses of antibiotics. Intravenous antibiotic treatment (mean of 7
days) of 767 hospitalised patients with P. aeruginosa bacteraemia
had a 1% discontinuation rate due to adverse effects (22). When
including patients who did not respond to treatment in this group, this
still only represents 38-46% vs 63% seen in our cohort. Long-term
intravenous antibiotic use in other infective conditions found a 45%
incidence rate of adverse drug effects and an increased duration of
treatment in those affected (23). They did not report the frequency of
antibiotic regime changes or dose alterations.