Reimagining Long-term Antibiotics in Persons Who Inject Drugs: Time to Shift the Status Quo?

Authors

Jesse Theisen-Toupal, Veterans Affairs Medical Center
Elana S. Rosenthal, DC Partnership for HIV/AIDS Progress
Christopher F. Rowley, Beth Israel Deaconess Medical Center

Date of this Version

2016

Citation

Journal of Hospital Medicine Vol 11 No 8 August 2016

Comments

U..S. Government Work

Abstract

In the United States, there are an estimated 744,000 individuals who have engaged in recent injection drug use (IDU) and 6.6 million individuals who have ever injected a drug.1 The practice of IDU predisposes individuals to serious bacterial and fungal infections that often require long-term intravenous antibiotics. In individuals without IDU, these serious infections are often treated with outpatient parenteral antibiotic therapy (OPAT). However, a different standard exists for many persons who inject drugs (PWID)—the mandated completion of antibiotics in an inpatient setting.

Though mandating inpatient antibiotic therapy for PWID is a widely adopted standard, this practice is not evidence based and may increase overall costs to the healthcare system. In 2012, in a qualityimprovement initiative, UKHealthCare established a protocol for treating appropriate PWID with OPAT.2 They found very few inpatient providers willing to discharge PWID on OPAT, even with an established protocol.