The Infectious Diseases Society of America (IDSA) has updated their 2004 clinical practice guideline on outpatient parenteral antimicrobial therapy (OPAT), which is defined as the “administration of parenteral antimicrobial therapy in at least 2 doses on different days without intervening hospitalization.” The updated guidelines have been published in Clinical Infectious Diseases.

Key recommendations include:

  • Patients or caregivers should be allowed to self-administer OPAT (strong recommendation, low-quality evidence).
  • Patients or caregivers should be allowed to self-administer OPAT at home without visiting nurse support, as long as protocols are in place for effective monitoring of complications and adverse effects (weak recommendation, low-quality evidence).
  • Elderly patients should be allowed to receive OPAT at home (strong recommendation, low-quality evidence).
  • There are no recommendations as to whether infants aged <1 month may be treated with OPAT at home (no recommendation, very low-quality evidence), and decisions need to be made on a case-by-case basis.
  • Serial laboratory testing should be monitored in patients receiving OPAT (strong recommendation, high-quality evidence), but data are currently insufficient as far as making that are evidence-based recommendation regarding specific tests or monitoring frequency for individual antimicrobial agents.
  • For patients receiving vancomycin, blood levels should be measured regularly throughout the course of treatment (strong recommendation, very low-quality evidence).
  • Before the initiation of OPAT, all patients should have an infectious disease expert review (strong recommendation, very low-quality evidence).
  • For patients with no history allergic reaction to antibiotics, it may be allowed that the first dose of OPAT be administered at home, under the supervision of a healthcare professional (weak recommendation, very low quality evidence).

 

Researchers also advised and identified multiple specific areas for possible future research in efficacy and safety of OPAT. Specifically, researchers stressed the importance of newer models of care for people who inject drugs, citing a growing demographic of patients as a result of the recent opiate addiction crisis. Researchers also noted the necessity for more information on safety and efficacy of treatment of persons aged <1 month, as well in the area of delivery of OPAT via midline catheters and peripheral catheters.

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Reference

Norris AH, Shrestha NK, Allison GM, et al. 2018 IDSA clinical practice guideline for the management of outpatient parenteral antimicrobial therapy [published online November 13, 2018]. Clin Infect Dis. doi: 10.1093/cid/ciy745