Home intravenous antibiotics

Information for clinicians caring for children receiving intravenous antimicrobials at home.

In For health professionals

Home intravenous antimicrobials

Some patients may be eligible for intravenous antimicrobial treatment at home through our CHQ at Home and Hospital in the Home (HITH) service.

Help and referrals

If you work for Children's Health Queensland, access the referral and eligibility information on the intranet. To refer your patient contact the CHQ at Home team.

CHQ at Home Registrar

Page via QCH Switchboard: 07 3068 1111

CHQ at Home Nurse coordinator

Phone: 0432 003 030

You'll also need approval from the infectious disease (ID) specialist or fellow for all home intravenous antimicrobial treatments. Call 07 3068 1111 to request approval. For help and advice with medicine suitability and dosing call us or the CHQ at Home pharmacist.

CHQ at Home pharmacist

Phone: 0437 976 230

Antimicrobial stewardship pharmacist

Phone: 0436 815 492

Approved HITH pathways are available for patients who:

have cystic fibrosis [PDF 613.07 KB] and are receiving Tobramycin, Piperacillin-Tazobactam or Ceftazidime treatment
have non-cystic fibrosis bronchiectasis [PDF 458.54 KB] and are receiving Ceftriaxone treatment
are admitted by the oncology team with low risk febrile neutropenia (for Queensland Heath staff on the intranet) and are receiving 24 hour clinical reviews by an oncologist or infectious disease specialist.

Patients presenting to the emergency department are also eligible for the HITH pathway if they meet the meet the CHQ Hospital In the Home antibiotic guideline [PDF 443.46 KB] criteria for:

community acquired pneumonia
cellulitis
lymphadenitis
peri-orbital cellulitis
urinary tract infections
pyelonephritis.

Home IV antimicrobial prescribing guidelines

Before you prescribe an antimicrobial for home use consider the medicine's:

safety and effectiveness
appropriate intravenous access
appropriate dosage
medicine stability such as the temperature of the environment where it will be stored or used
device for administration such as a springfusor, infusion bag with pump or elastomeric device.

If you work for Children's Health Queensland, read the following home antimicrobial and administration device guidelines on the intranet.

Search parenteral antimicrobials and suitability for home use

Intravenous antimicrobials	HITH suitability, suggested dosing schedule and type of intravenous access required
Aciclovir	Suitable for HITH - seek ID specialist advice 24 hour continuous infusion PICC line or CVAD required, Not suitable for administration via PIVC
Amikacin	Suitable for HITH Administer once daily and infuse over 30 minutes Seek ID team and pharmacist advice on dosing and therapeutic drug monitoring Peripheral IV cannula (PIVC) or CVAD For HITH treatment more than 7 days a PICC line, midline or CVAD is required
Ampicillin	Not suitable for HITH Not stable at room temperature as 24 hour continuous infusion Seek ID team advice for alternative treatment option
Amoxicillin (Amoxycillin)	Not suitable for HITH Not stable at room temperature as 24 hour continuous infusion Seek ID team advice for alternative treatment option
Amoxicillin/clavulanate	Not suitable for HITH Not stable at room temperature as 24 hour continuous infusion Seek ID team advice for alternative treatment option
Amphotericin B (liposomal) (Ambisome)	Suitable for HITH Administer once daily and infuse over 60 minutes or longer PICC line or CVAD is required, not suitable for administration via midline
Anidulafungin	Suitable for HITH Administer once daily and infuse over 60 minutes or longer, with max infusion rate of 1.1 mg/minute Peripheral IV cannula (PIVC) or CVAD For HITH treatment more than 7 days a PICC line or CVAD is required
Azithromycin	Not suitable for HITH Seek ID team advice for alternative treatment option
Aztreonam	Suitable for HITH 24-hour continuous infusion HITH options: 24 hour dose prepared in IV bag for administration via AmBIT pump with PICC line, midline or CVAD required 24 hour dose infused via elastomeric device with PICC line, midline or CVAD required and monitoring of device dose delivery
Benzylpenicillin (with citrate buffer)	Suitable for HITH Administer as 24 hour continuous infusion HITH options: 24 hour dose prepared in IV bag for administration via AmBIT pump with PICC line, midline or CVAD required (a PIVC may be suitable in older children for short term courses, contact the ID team for advice) 24 hours dose infused via elastomeric device with PICC line, midline or CVAD required –monitor infusor function Queensland Health staff can view the elastomeric infusor device infusion record on the intranet
Caspofungin	Suitable for HITH Administer once daily and infuse over 1 hour Seek ID team and pharmacist advice PICC line or CVAD required, not suitable for administration via PIVC
Cefepime	Suitable for HITH Administer as 8 hourly or 6 hourly dosing with each dose administered over 30 minutes via intermate ambulatory device PICC line or CVAD required, not suitable for administration via PIVC Not stable as 24 hour continuous infusion at room temperature or above Doses administered by parents or carers after successful completion of CHQ competency training package 'Guide to giving your child’s IV antibiotic at home – for children with PICC lines'
Cefotaxime	Not suitable for HITH Not stable at room temperature as 24 hour continuous infusion Seek ID team advice for alternative treatment options such as Ceftriaxone in patients more than 1 month of age
Cefoxitin	Suitable for HITH Administer as 24 hour continuous infusion HITH options: 24 hour dose prepared in IV bag for administration via AmBIT pump with PICC line, midline or CVAD required 24 hours dose infused via elastomeric device with PICC line, midline or CVAD required –monitor infusor function Queensland Health staff can view the elastomeric infusor device infusion record on the intranet
Ceftazidime	Suitable for HITH Administer as 8 hourly dosing with each dose administered over 30 minutes via intermate ambulatory device PICC line or CVAD required Not suitable for administration via PIVC Not stable as 24hour continuous infusion at room temperature or above Doses administered by parents or carers after successful completion of CHQ competency training package 'Guide to giving your child’s IV antibiotic at home – for children with PICC lines'
Ceftolozane-tazobactam	Suitable for HITH Administer as 24 hour continuous infusion 24 hour dose prepared in IV bag for administration via AmBIT pump with PICC line, midline or CVAD required
Ceftriaxone	Suitable for HITH Administer once daily and infuse over 30 minutes Peripheral IV cannula (PIVC) or CVAD For HITH treatment more than 7 days a PICC line, midline or CVAD is required
Cefazolin	Suitable for HITH Administer as 24 hour continuous infusion HITH options: 24 hour dose prepared in IV bag for administration via AmBIT pump (PIVC may be suitable in older children for short term courses, contact the ID team for advice) 24 hours dose infused via elastomeric device (peripherally inserted venous cannula – PIVC) with minimum 22 gauge, PICC line, midline or CVAD required – monitor infusor function Queensland Health staff can view the elastomeric infusor device infusion record on the intranet
Ertapenem	Suitable for HITH Seek ID team advice on appropriate dosing regimen Peripheral IV cannula (PIVC) or CVAD For HITH treatment more than 7 days, PICC line, midline or CVAD required. HITH options: For children under 12 years of age: Administer twice daily dosing required Infused via springfusor over 30 minutes Requires twice daily HITH visits Discuss with ID and HITH SMO For children over 12 years of age: Administer once daily dosing appropriate Infused via spring fusor over 30minutes
Flucloxacillin (with citrate buffer)	Suitable for HITH Administer as a 24 hour continuous infusion HITH options: 24 hour dose prepared in IV bag for administration via AmBIT pump with PICC line, midline or CVAD required 24 hours dose infused via elastomeric device with PICC line or CVAD required – Monitor infusor function Queensland Health staff can view the elastomeric infusor device infusion record on the intranet Risk of thrombophlebitis if administered via PIVC or midline
Fluconazole	Suitable for HITH Administer once daily and infuse over 2 to 3 hours depending on the dose Peripheral IV cannula (PIVC) or CVAD For HITH treatment more than 7 days a PICC line, midline or CVAD required
Foscarnet	Suitable for HITH – seek ID specialist advice Administer as a 24 hour continuous infusion Caution: Close monitoring of renal function, electrolytes and fluid balance required HITH options: 24 hour dose prepared in IV bag for administration via AmBIT pump with PICC line or CVAD required Cytotoxic handling precautions
Ganciclovir	Seek ID team specialist advice Cytotoxic agent PICC line or CVAD required. Not suitable for administration via PIVC or midline.
Gentamicin	Suitable for HITH Administer once daily and infuse over 30 minutes via springfusor Seek ID team and pharmacist advice on dosing and therapeutic drug monitoring Peripheral IV cannula (PIVC) or CVAD For HITH treatment more than 7 days a PICC line, midline or CVAD is required
Imipenem/cilastatin	Not suitable for HITH Not stable at room temperature as 24 hour continuous infusion Seek ID team advice for alternative treatment option
Lincomycin	Suitable for HITH Administer as a 24 hour continuous infusion 24 hour dose prepared in IV bag for administration via AmBIT pump (PIVC may be suitable in older children for short term courses, contact the ID team for advice)
Meropenem	Not suitable for HITH Not stable at room temperature as 24 hour continuous infusion Seek ID consultant or fellow advice for alternative treatment option
Micafungin	Suitable for HITH Administer once daily and infuse over at least 60 minutes PICC line or CVAD required
Piperacillin/tazobactam (citrate buffered)	Suitable for HITH 24 hour continuous infusion HITH options: 24 hour dose prepared in IV bag for administration via AmBIT pump (PIVC may be suitable in older children for short term courses, contact the ID team for advice) 24 hour dose infused via elastomeric device with PICC line, midline or CVAD required – monitor infusor function Queensland Health staff can view the elastomeric infusor device infusion record on the intranet
Teicoplanin	Suitable for HITH Administer once daily and infuse over 5 to 30 minutes Seek ID team and pharmacist advice on dosing and therapeutic drug monitoring Peripheral IV cannula (PIVC) or CVAD For HITH treatment more than 7 days a PICC line, midline or CVAD required
Tobramycin	Suitable for HITH Administer once daily infuse over 30 minutes via spring fusor Seek ID team and pharmacist advice on dosing and therapeutic drug monitoring Peripheral IV cannula (PIVC) or CVAD For HITH treatment more than 7days, PICC line, midline or CVAD required
Vancomycin	Suitable for HITH Administer as a 24 hour continuous infusion Seek ID team and pharmacist advice on dosing and therapeutic drug monitoring Not suitable for administration via PIVC or midline HITH options: 24 hour dose prepared in IV bag for administration via AmBIT pump 24 hour dose infused via elastomeric device with PICC line or CVAD required – monitor infusor function Queensland Health staff can view the elastomeric infusor device infusion record on the intranet
Voriconazole	Not suitable for HITH Seek ID team advice for alternative treatment option No current stability data for continuous infusion in elastomeric device

Supportive medication orders required for patients receiving IV antimicrobials at home

Prescribe the following supporting medicines in addition to the parenteral antimicrobial orders in ieMR before you transfer your patient from inpatient to the HITH service.

Medicine	Dosage	Usage considerations
Sodium Chloride 0.9% flush	5-10 mL IV PRN	To flush IV access device pre and post medication administration Some medicines are not compatible with sodium chloride 0.9 % and may require glucose 5 % as an IV flush
Long term heparin lock	Dilute 1 mL of 1000 units/mL Heparin with 9 mL Sodium Chloride 0.9%. Final concentration of 100 units/mL heparin. Use 1 to 2 mL IV PRN as along term heparin lock (volume is dependent on type of device)	Use for more than 24 hours Not to be used for haemophilia patients
Cetirizine (Zyrtec)	1 to 2 years of age 0.25 mg/kg/dose (up to 2.5 mg/dose), twice daily PO 2 to 5 years of age 5 mg, daily PO (can divide into 2 doses) 6 to 12 years of age 10 mg, daily PO (can divide into 2 doses)	Chart as PRN order Use in the event of allergic reaction
Adrenaline (Epipen)	If less than 20 kg: Give 150 microgram as intramuscular injection If more than 20 kg: Give 300 microgram as intramuscular injection	Chart as a once only PRN order Intramuscular injection Use in the event of anaphylaxis Quantify indications for administration under order

External resources

Australian therapeutic guidelines for HITH on the Therapeutic Guidelines website
Elastomeric products’ professional guide on the Baxter website
Patient guide – infusor on the Baxter website

Last updated: October 2023