Intravenous therapy

Denyer S.R (1982) In-use contamination in intoavenous dierq)y—die scale of die problem. In Infusions and Infection. The Hazards of In-use Contamination in Intravenous Therapy qA RF. D Arcy), pp. 1-16. Oxford Medicine Publishing Foundation. 

Initiate early, aggressive, and empiric intravenous therapy... 

Focus on (1) acute improvement of symptoms and hemodynamics due to intravenous therapies (2) criteria for a safe discharge from the hospital and (3) optimization of oral therapy. 

Alternatively, initial intravenous therapy can be omitted Propranolol... 

Recent studies show equal efficacy of equivalent doses of intravenous and oral dosage forms.30,31 Some clinicians are now using oral prednisone for patients experiencing relapses to avoid the discomfort, inconvenience, and expense of intravenous therapy. 

Prompt initiation of intravenous high-dose cidal antimicrobial therapy directed at the most likely pathogen (s) is essential due to the high morbidity and mortality associated with CNS infections parenteral (intravenous) therapy is administered for the full course of therapy for CNS infections to ensure adequate CSF penetration throughout the course of treatment. 

Palmer 1989 Robinson et al.1983). However, the ratio was almost certainly affected by initial chelation with Ca-DPTA, followed by daily intravenous therapy with the chelating agent, Zn-DPTA, treatments that would have increased the urinary excretion of americium (Breitenstein and Palmer 1989). The above not withstanding, the observations made on this subject demonstrate that fecal excretion was an important pathway of excretion in this subject long after mechanical clearance of americium from the respiratory tract would have been complete. This is consistent with observations made in nonhuman primates that show that americium is excreted into bile (see Section 3.4.4.4). However, the extent to which the biliary excretion pathway in humans might resemble that of nonhuman primates is not known. 

All severe infections should be treated with intravenous therapy. After initial response, step-down therapy to oral agents can be used. 

Treatment options for patients requiring intravenous therapy include /J-lactam-/3-lactamase inhibitors (ampicillin-sulbactam or piperacillin-tazobactam), second-generation cephalosporins with antianaerobic activity (cefoxitin), and carbapenems. 

III.c.2.2. Intravenous versus oral therapy. Intravenous therapy (IVT) generates maximum, fast, and long lasting efficacy with minimum adverse effects while the efficacy of oral therapy is less, slow and short lasting with more potential for adverse effects. 

She is symptomatic and may benefit from a short course of high-intensity intravenous therapy with a cAMP-elevating agent (e.g., dobutamine, milrinone, amrinone). This may be a reversible event or part of the inevitable decline of the disease process. Approximately 45% of CHE patients die suddenly of a presumed electrical event (e.g., ventricular tachycardia, asystole). The others die slowly of progressive deterioration. Many patients at the end stages of CHE prefer to try repeated outpatient inotropic (cAMP elevating) therapy for symptomatic... 

Penicillin G (benzylpenicillin) is an acid-labile compound having variable bioavailability after oral administration. Consequently, penicillin G is most appropriate for intramuscular or intravenous therapy. The drug distributes to most tissues and serosa-lined cavities, although low concentrations appear in breast milk and... 

Renal function, urinalysis (especially serum creatinine and urine protein prior to each dose), and blood chemistry (to include serum uric acid, phosphate, and bicarbonate), white counts with differential during intravenous therapy... 

However, short-acting, regular soluble insulin is the only type that should be administered intravenously because the dilution causes the hexameric insulin to immediately dissociate into monomers. It is particularly useful for intravenous therapy in the management of diabetic ketoacidosis and when the insulin requirement is changing rapidly, such as after surgery or during acute infections. 

The fundamental treatment for DKA includes aggressive intravenous hydration and insulin therapy and maintenance of potassium and other electrolyte levels. Fluid and insulin therapy is based on the patient s individual needs and requires frequent reevaluation and modification. Close attention has to be given to hydration and renal status, the sodium and potassium levels, and the rate of correction of plasma glucose and plasma osmolality. Fluid therapy generally begins with normal saline. Regular human insulin should be used for intravenous therapy with a usual starting dose of about 0.1 IU/kg/h. 

Quinidine Quinoline methanol Intravenous therapy of severe infections with P falciparum... 

The toxicity of aluminum has been recognized most clearly by the development of bone disease caused by deposition of A1 in bones of patients on hemodialysis and in infants on intravenous therapy/ 6 Excessive A1 in the water used for dialysis may also cause brain damage. Dietary aluminum may be one cause of Alzheimer s disease/ h but this is controversial as is a possible role of aluminum in vaccines in causing inflammation in muscle.1) Solubilization of soil aluminum by acid rain has been blamed for the decline of forests in Europe and North America,) for the death of fish in acid waters,k and for very large reductions in yield for many crops/ An aluminum-resistant strain of buckwheat makes and secretes from its roots large amounts of oxalate which binds and detoxifies the Al3+ ions. ... 

Sedman AB, Klein GL, Merritt RJ, et al. 1985. Evidence of aluminum loading in infants receiving intravenous therapy. N Engl J Med 312 1337-1342. 

Cardiovascular Disorders. DA itself is a useful agonist where intravenous therapy is required for immediate effects limited to the periphery (i.e. outside the blood Drain barrier). It has therefore been employed as a pharmacolgical agent in shock - a condition in which there is no disease involving dopaminergic mechanisms, but where the inotropic actions on the heart and vasodilator effects on the kidney can reverse the potentially lethal consequences of profound arterial hypotension, whatever its cause. This subject is discussed in detail elsewhere in this symposium. 

The advantages of transdermal delivery can be summarised as follows. Oral absorption in the neonate is unpredictable leading to variable drug levels in the plasma and drug input cannot be readily terminated after oral dosage. Intravenous therapy is complicated by the large dead volume of the access line compared to the small drug and plasma volume in preterm infants. 

For a severe pneumonia, the dose of ceftriaxone may be increased to 2 g once daily and no dose adjustment is required in moderate renal impairment. Intravenous therapy is indicated in severe or life-threatening infection or where there are concerns about absorption of oral therapy. 

Switching from intravenous to oral antibiotics should be considered as soon as clinically appropriate. Prolonged intravenous therapy is associated with risk of intravascular device-related infection and delays discharge. Indicators for switch include resolution of fever, tachycardia, tachypnoea, hypotension and hypoxia and the patient should be clinically hydrated with good oral intake and no gastrointestinal absorption concerns. 

Infections limited to soft tissue will require between 7 and 10 days of intravenous therapy followed by an additional 14 days of oral therapy (total duration 2-4 weeks). If MRSA is isolated, intravenous vancomycin must not be switched to oral vancomycin which has negligible absorption from the gastrointestinal tract. Oral agents may be selected from rifampicin, tetracyclines, fusidic acid or trimethoprim depending on sensitivity data and a combination of two agents is recommended. Oral linezolid monotherapy is an effective alternative. 

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