Outpatient parenteral antibiotic therapy

Outpatient parenteral antibiotic therapy
Other namesOPAT

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]

AntibioticStability at 25 °CDiluentExisting data in elastomeric pumps
cefepime24 hoursnormal salineYes
ceftazidime48 hoursnormal salineYes
clindamycin16 daysdextrose 5%No
flucloxacillin24 hoursnormal salineYes
fosfomycin24 hourswater for injectionNo
oxacillin24 hoursnormal salineNo
benzylpenicillin potassium24–48 hoursringer acetateYes
benzylpenicillin sodium12–24 hoursnormal salineYes
piperacillin/tazobactam24 hoursnormal salineYes
vancomycin7 daysnormal salineYes

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

  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.


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