Outpatient parenteral antibiotic therapy explained
| Outpatient parenteral antibiotic therapy |
| Synonym: | OPAT |
Outpatient parenteral antibiotic therapy (OPAT) is used to administer non-oral antibiotics (usually intravenously) without the need for ongoing hospitalisation. OPAT is particularly useful for people who are not severely ill 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 an outpatient facility (including a provider's office, infusion center or day hospital) or at a patient's residence using an infusion pump, such as an elastomeric pump.[3] [4]
Common antimicrobials
Common antimicrobials used for continuous infusion are shown below:[5]
| 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
[6] [7] Notes and References
- Chapman. A. L. N.. Outpatient parenteral antimicrobial therapy. BMJ. 26 March 2013. 346. mar26 1. f1585. 10.1136/bmj.f1585. 23532865. 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. en. 73. 9. 2540–2545. 10.1093/jac/dky224. 29982449. 0305-7453.
- Docherty T, Schneider JJ, Cooper J . Clinic- and Hospital-Based Home Care, Outpatient Parenteral Antimicrobial Therapy (OPAT) and the Evolving Clinical Responsibilities of the Pharmacist . Pharmacy . 8 . 4 . December 2020 . 233 . 33297356 . 7768382 . 10.3390/pharmacy8040233. free .
- Spencer-Jones J, Luxton T, Bond SE, Sandoe J . Feasibility, Effectiveness and Safety of Elastomeric Pumps for Delivery of Antibiotics to Adult Hospital Inpatients-A Systematic Review . Antibiotics . 12 . 9 . August 2023 . 1351 . 37760648 . 10525832 . 10.3390/antibiotics12091351 . free . Elastomeric infusion pumps (EMPs) have been implemented in many fields, including analgesia, chemotherapy and cardiology. Their application in antimicrobials is mainly limited to the outpatient setting, but with a need to optimise inpatient antimicrobial treatment, the use of EMPs presents a potential option..
- 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. en. 9. 7. 398. 10.3390/antibiotics9070398. 2079-6382. 7399849. 32664288. free.
- 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. en. 35. 2. 156–163. 10.1016/j.ijantimicag.2009.10.008. 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. en. 40. 3. 259–265. 10.1111/jcpt.12270. 25865426. free.
