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.