Rationale:

• The growing demand for acute medical care can put considerable pressure on finite inpatient resources. Outreach models of care for cellulitis can provide safe alternatives, permitting more rational use of acute medical beds.
• Many patients prefer to receive outpatient parenteral antibiotic therapy or oral antimicrobials in the community rather than be admitted as inpatients. Patient satisfaction for outpatient parenteral antibiotic therapy is generally higher than that for inpatient care.

Evidence:

• Clinical outcomes comparable to hospitalized patients have been well demonstrated in a randomized, controlled trial of outpatient parenteral antibiotic therapy (65). No increase in adverse events was noted in patients treated by outpatient parenteral antibiotic therapy (66).
• Economic analyses suggest that home-based therapy is at least as cost effective as inpatient care. It is difficult to assess the real cost/benefit in both groups in terms of the impact on the patient's quality of life and rate of convalesence, which may be more rapid using outpatient parenteral antibiotic therapy (61; 62; 67; 68).
• Most of the studies published are based on cephalosporin use (69). Where possible, narrow-spectrum antibiotic use has been preferred (70).

Comments:

• If the data on more rapid convalesence in the home setting compared to hospitalization is supported by further studies, it will redefine how most patients with cellulitis and soft tissue infection are treated.