Place of parenteral cephalosporins in the ambulatory setting: clinical evidence.

During the last decade, 6 parenteral third generation cephalosporins have been introduced into clinical practice. The three most frequently used agents are cefotaxime, ceftazidime and ceftriaxone. Although primarily used in hospitals, these agents are increasingly employed in the ambulatory setting. In particular, ceftriaxone, because of its favourable pharmacokinetic profile allowing once-daily administration by a bolus injection, has demonstrated both tolerability and efficacy in the ambulatory setting during extensive worldwide use. Sophisticated parenteral infusion systems enable cephalosporins that require more frequent administration to be delivered in this setting. In noncomparative studies involving a range of patient populations and serious infections (mostly bone, joint and soft tissue, and pneumonia and febrile episodes in neutropenia), these cephalosporins achieved equivalent efficacy and tolerability, and considerable cost savings, since patients were able to receive all or part of their treatment in the home or outpatient setting. However, more comparative studies of ambulatory parenteral therapy in the inpatient setting or ambulatory oral therapy are necessary to further clarify the true cost effectiveness of this type of healthcare delivery. This is increasingly relevant in countries where parenteral antimicrobials are not the 'standard of care' in managing many serious infections. Published experience to date confirms that third generation cephalosporins, particularly ceftriaxone, should have an essential place in the therapeutic formulary of any ambulatory parenteral antibiotic programme.