Tolerance of subcutaneously administered antibiotics: a French national prospective study.
Although poorly documented, subcutaneous (SC) administration of antibiotics is common practice in France especially in Geriatrics Departments. The aim of this study was to determine the tolerance of such a practice.



Prospective observational multicentre study.



Sixty-six physicians accepted to participate from 50 French Infectious Diseases and Geriatrics Departments. From May to September 2014, patients treated at least one day with SC antibiotics could be included. Modalities of subcutaneous administration, occurrence of local and systemic adverse effects (AE) and clinical course were collected until the end of the treatment.



Two hundred-nineteen patients (83.0 [19–104] yo) were included. Ceftriaxone (n = 163, 74.4%), and ertapenem (n = 30, 13.7%) were the most often prescribed antibiotics. The SC route was mainly used because of poor venous access (65.3%) and/or palliative care (32.4%). Fifty patients (22.8%) experienced at least one local AE that led to an increased hospital stay for two patients (4.0%) and a discontinuation of the SC infusion in six patients (12.0%). A binary logistic regression for multivariate analysis identified the class of antibiotic (p = 0.002) especially teicoplanin and the use of rigid catheter (p = 0.009) as factors independently associated with AE. In over 80% of cases, SC antibiotics were well tolerated and associated with clinical recovery.



SC administration of antibiotics leads to frequent but local and mild AE. Use of non-rigid catheter appears to be protective against AE. As it appears to be a safe alternative to the intravenous route, more studies are needed regarding efficacy and pharmacokinetics.
Pôle de Gérontologie Clinique, Centre Hospitalier Universitaire - Hôpitaux de Bordeaux, Université de Bordeaux, F-33000 Bordeaux, France.
Claire
C
Roubaud-Baudron
Service de Maladies Infectieuses, Centre Hospitalier Métropole Savoie, F-73000 Chambéry, France.
Emmanuel
E
Forestier
Court Séjour Gériatrique Aigu, Centre Hospitalier Alès-Cévennes, F-30100 Alès, France.
Thibaut
T
Fraisse
Service de Maladies Infectieuses, Centre Hospitalier Annecy Genevois, F-74000 Annecy, France.
Jacques
J
Gaillat
Médecine Interne Gériatrique, Centre Hospitalier Universitaire de Nîmes, F-30000 Nimes, France.
Benoit
B
de Wazières
Service de Maladies Infectieuses, Centre Hospitalier Annecy Genevois, F-74000 Annecy, France.
Leonardo
L
Pagani
Pôle Biologie, Pharmacie et Santé Publique, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, F-86000 Poitiers, France|INSERM, CIC 1402, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, F-86000 Poitiers, France
Isabelle
I
Ingrand
Service de Maladies Infectieuses, Centre Hospitalier Régional Universitaire Bretonneau, F-37000 Tours, France.
Louis
L
Bernard
Clinique Universitaire de Médecine Gériatrique, Centre Hospitalier Universitaire de Grenoble, F-38000 Grenoble, France.
Gaëtan
G
Gavazzi
Pôle de Gériatrie, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, F-86000 Poitiers, France|Intergroupe SPILF-SFGG
Marc
M
Paccalin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D057785:Catheters; D004334:Drug Administration Schedule; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology; D004867:Equipment Design; D005260:Female; D005602:France; D006801:Humans; D055104:Infusions, Subcutaneous; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
D000900:Anti-Bacterial Agents