Acute Bacterial Skin and Skin Structure Infections: Advantages and Disadvantages of Early Discharge and Outpatient Parenteral Antibiotic Therapy

Abstract

Acute bacterial skin and skin structure infections (ABSSSI) can require long periods of antibiotic therapy. If an ABSSSI is treated while a person is in hospital, this may lead to an extended hospital stay of days or even weeks, even if the patient is in a stable enough medical condition to be discharged to their home environment. As such, inpatient treatment of an ABSSSI can incur high costs for the hospital and tie up beds that could be used for other patients. Michael Wilke from Inspiring-health GmbH, Munich, Germany, and the Medical School Hamburg, Germany, discussed with the EMJ how early discharge may be viable for patients who are medically stable and can either return to the hospital for daily treatment with intravenous (IV) infusions or are able to, reliably, take oral antibiotics. Also available are the long-acting antibiotics oritavancin and dalbavancin. The latter is administered only once via IV infusion. While the cost per dose of dalbavancin is more expensive than most oral or daily/twice daily IV antibiotic regimens, its use can facilitate early discharge, leading to reduced hospital stays and offset cost savings. Due to the administration schedule, the use of long-acting antibiotics circumvents issues with daily medication adherence.