Instant messaging for outpatient intramuscular antibiotic therapy adherence: proof of concept

Abstract

Objective: Outpatient antimicrobial therapy works but often requires in-person oversight. Advancements enable seamless communication. We used instant messaging to track adherence, cost, efficacy, and adverse events for outpatient intramuscular antibiotic therapy.

Material and methods: We invited eligible inpatients with bacterial isolates susceptible to ceftriaxone, cefepime, ceftazidime, meropenem, or ertapenem and a positive clinical response to infection to join the study. Participants received antibiotics and submitted daily photos of the used vial through an instant messaging application. After treatment, we conducted virtual follow-ups on days 14 and 28. We asked subjects about adverse events or ongoing symptoms. Any concerns prompted a recommendation to come back for additional evaluation. We calculated the economic impact using the number of outpatient days as reduced hospitalization days, the cost of materials, and nursing personnel expenses.

Results: A total of 30 patients were included; 90% of the subjects showed good adherence, while five exhibited protocol deviations. We observed a 38.3% reduction in hospital costs. Treatment failure occurred in 13.7%, resulting in one readmission. We found no significant adverse events.

Discussion: Integrating WhatsApp enhances healthcare through a free, user-friendly model. It boosts communication, privacy, and antibiotic effectiveness, improving outcomes. Our low-cost approach aids monitoring, particularly in resource-limited settings. Some limitations include no control group, specific intramuscular criteria, and limited expertise. These findings guide future projects and IT-based care models.

Conclusions: The 90% adherence rate in this study serves as a proof-of-concept for instant messaging as an adherence tool for timely deviation identification and enhancing institutional savings during outpatient antibiotic therapy.