Outpatient parenteral antibiotic therapy

Outpatient parenteral antibiotic therapy
Outpatient parenteral antibiotic therapy
Other names	OPAT

Outpatient parenteral antibiotic therapy (OPAT) is used to administer non-oral antibiotics (usually intravenously) without a need for ongoing hospitalisation. OPAT is particularly useful in people who are not severely unwell but do require a prolonged course of treatment that cannot be given in oral form.[1] OPAT is being increasingly adopted as part of antimicrobial stewardship programs, it can reduce length of stay, costs and adverse events while improving quality of life.[2] OPAT can be administered in Day Hospital or as part of home assistance care using elastomeric pumps.

Common antimicrobials

Common antimicrobials used for continuous infusion are shown below:[3]

Antibiotic	Stability at 25 °C	Diluent	Existing data in elastomeric pumps
cefepime	24 hours	normal saline	Yes
ceftazidime	48 hours	normal saline	Yes
clindamycin	16 days	dextrose 5%	No
flucloxacillin	24 hours	normal saline	Yes
fosfomycin	24 hours	water for injection	No
oxacillin	24 hours	normal saline	No
benzylpenicillin potassium	24–48 hours	ringer acetate	Yes
benzylpenicillin sodium	12–24 hours	normal saline	Yes
piperacillin/tazobactam	24 hours	normal saline	Yes
vancomycin	7 days	normal saline	Yes

Before starting beta-lactams and vancomycin infusion, it is advisable to administer a loading dose in order to reduce time to reach target concentrations[4][5]

References

Chapman, A. L. N. (26 March 2013). "Outpatient parenteral antimicrobial therapy". BMJ. 346 (mar26 1): f1585. doi:10.1136/bmj.f1585. PMID 23532865. S2CID 38761363.
Voumard, Rachel; Gardiol, Céline; André, Pascal; Arensdorff, Lyne; Cochet, Camille; Boillat-Blanco, Noémie; Decosterd, Laurent; Buclin, Thierry; de Vallière, Serge (2018-09-01). "Efficacy and safety of continuous infusions with elastomeric pumps for outpatient parenteral antimicrobial therapy (OPAT): an observational study". Journal of Antimicrobial Chemotherapy. 73 (9): 2540–2545. doi:10.1093/jac/dky224. ISSN 0305-7453. PMID 29982449.
Di Bella, Stefano; Beović, Bojana; Fabbiani, Massimiliano; Valentini, Michael; Luzzati, Roberto (2020-07-10). "Antimicrobial Stewardship: From Bedside to Theory. Thirteen Examples of Old and More Recent Strategies from Everyday Clinical Practice". Antibiotics. 9 (7): 398. doi:10.3390/antibiotics9070398. ISSN 2079-6382. PMC 7399849. PMID 32664288.
Roberts, Jason A.; Kirkpatrick, Carl M.J.; Roberts, Michael S.; Dalley, Andrew J.; Lipman, Jeffrey (February 2010). "First-dose and steady-state population pharmacokinetics and pharmacodynamics of piperacillin by continuous or intermittent dosing in critically ill patients with sepsis". International Journal of Antimicrobial Agents. 35 (2): 156–163. doi:10.1016/j.ijantimicag.2009.10.008. PMID 20018492.
Waineo, M. F.; Kuhn, T. C.; Brown, D. L. (June 2015). "The pharmacokinetic/pharmacodynamic rationale for administering vancomycin via continuous infusion". Journal of Clinical Pharmacy and Therapeutics. 40 (3): 259–265. doi:10.1111/jcpt.12270. PMID 25865426.

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[1] Chapman, A. L. N. (26 March 2013). "Outpatient parenteral antimicrobial therapy". BMJ. 346 (mar26 1): f1585. doi:10.1136/bmj.f1585. PMID 23532865. S2CID 38761363.

[2] Voumard, Rachel; Gardiol, Céline; André, Pascal; Arensdorff, Lyne; Cochet, Camille; Boillat-Blanco, Noémie; Decosterd, Laurent; Buclin, Thierry; de Vallière, Serge (2018-09-01). "Efficacy and safety of continuous infusions with elastomeric pumps for outpatient parenteral antimicrobial therapy (OPAT): an observational study". Journal of Antimicrobial Chemotherapy. 73 (9): 2540–2545. doi:10.1093/jac/dky224. ISSN 0305-7453. PMID 29982449.

[3] Di Bella, Stefano; Beović, Bojana; Fabbiani, Massimiliano; Valentini, Michael; Luzzati, Roberto (2020-07-10). "Antimicrobial Stewardship: From Bedside to Theory. Thirteen Examples of Old and More Recent Strategies from Everyday Clinical Practice". Antibiotics. 9 (7): 398. doi:10.3390/antibiotics9070398. ISSN 2079-6382. PMC 7399849. PMID 32664288.

[4] Roberts, Jason A.; Kirkpatrick, Carl M.J.; Roberts, Michael S.; Dalley, Andrew J.; Lipman, Jeffrey (February 2010). "First-dose and steady-state population pharmacokinetics and pharmacodynamics of piperacillin by continuous or intermittent dosing in critically ill patients with sepsis". International Journal of Antimicrobial Agents. 35 (2): 156–163. doi:10.1016/j.ijantimicag.2009.10.008. PMID 20018492.

[5] Waineo, M. F.; Kuhn, T. C.; Brown, D. L. (June 2015). "The pharmacokinetic/pharmacodynamic rationale for administering vancomycin via continuous infusion". Journal of Clinical Pharmacy and Therapeutics. 40 (3): 259–265. doi:10.1111/jcpt.12270. PMID 25865426.