Sue Hemsworth considers the evidence for good practice when intramuscular injections are unavoidable

In December 1999, the intramuscular (IM) route for the drug Erwinia L-Asparaginase was adopted in paediatric oncology units in the light of pharmacokinetic data which indicated that it results in a more even distribution of uptake. This cyotoxic drug, used in the treatment of children with acute lymphoblastic leukaemia (ALL), had been given previously as a subcutaneous (SC) injection. It is not possible to give L-Asparaginase as an intravenous (IV) infusion because of the risk of anaphylaxis.