70 Case report: a tale of successful subcutaneous antibiotics

Background Infection is a common clinical problem in the palliative care setting. Patients are often offered broad-spectrum parenteral antibiotics to comprehensively assess for clinical reversibility. Challenges arise where intravenous (IV) or intramuscular (IM) access is not forthcoming or tolerated. Some centres have reported use of subcutaneous antibiotics as a viable alternative. Case Presentation M, 62, with endometrial cancer and autism, was admitted to hospice for symptom management. She had recurring urinary tract infections (UTIs) which responded to IV antibiotics but it became increasingly difficult to gain IV access. M, and by extension her family, found IV cannulation very stressful. Management and Outcomes M developed a UTI while an inpatient in the hospice but usual routes of antibiotic administration were unreliable (oral) or unsuitable, due to the associated pain and distress (IM, IV). On Day2 of IV Tazocin for pseudomonas bacteremia, IV access failed. The novel option of giving subcutaneous piperacillin/tazobactam was discussed with her family, with which they agreed on her behalf. M's infection improved after completing 6 days of parenteral piperacillin/tazobactam (stopped 1 day early due to diarrhoea) and she returned to her baseline. She died peacefully 3 weeks later. Results and Conclusion This case demonstrates the effective and tolerable use of piperacillin/tazobactam via the subcutaneous route. This novel route of administration of a common broad-spectrum antibiotic offers a new modality for the treatment of infections where IV access may be difficult to obtain or intolerable for the patient. Contribution to practice and originality: This new practice broadens our treatment options for infection in the palliative care setting. It raises further possibilities, and ethical and practice related questions, about the feasibility of parenteral antibiotics outside of the acute care setting. Further research and practice reports are needed to fully understand the value and challenges of giving antibiotics subcutaneously.