Parenteral drug delivery for ambulatory antimicrobial therapy

Parenteral antimicrobial therapy in community-based programs is usually administered intravenously, but is occasionally given intramuscularly or subcutaneously.

Depending on the program, parenteral antimicrobial therapy can be administered by a specialist nurse, other health professional, or by the patient or carer.

When a patient or carer is responsible for administering the intravenous therapy, they must have 24-hour support available for any arising issues and either:

be trained and competent before the patient is admitted to the service
have a period of supervision until the patient or carer is competent to continue administration.

Due to the risk of anaphylaxis, the first dose of a parenteral antimicrobial should be given in a setting with appropriately trained staff and equipment – preferably in a hospital or, in carefully selected patients, in another setting supervised by staff trained in ambulatory parenteral antimicrobial therapy. Patients with a history of immune-mediated antimicrobial hypersensitivity, idiopathic anaphylaxis, or chronic idiopathic urticaria should always receive the first dose of parenteral antimicrobial therapy in hospitalNorris, 2019.

Note: Due to the risk of anaphylaxis, the first dose of a parenteral antimicrobial should be given in a setting with appropriately trained staff and equipment.

Ambulatory parenteral antimicrobial therapy services should have an anaphylaxis management policy that includes procedures for administration of intramuscular adrenaline (epinephrine), and staff should be appropriately trained. For information about managing anaphylaxis, see the Australasian Society of Clinical Immunology and Allergy (ASCIA) website.