IDSA revises guidelines on outpatient parenteral antimicrobial therapy

  • Norris AH & al.
  • Clin Infect Dis
  • 13 Nov 2018

  • curated by Liz Scherer
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • New Infectious Diseases Society of America (IDSA) guidelines highlight the role of infectious disease (ID) expert review before initiating outpatient parenteral antimicrobial therapy (OPAT).
  • Up to 39% of patients can be switched to an oral agent; some do not require OPAT.

Why this matters

  • Monitor serial laboratory testing in patients receiving OPAT.
  • Consider patient characteristics, infection, tolerance/response to therapy, social factors to determine follow-up frequency.
  • Measure vancomycin blood levels regularly throughout OPAT (at least 1/week with stable renal function).

Key points

  • Self-administered, home-based OPAT without visiting nurse support is acceptable.
    • Implement system for monitoring vascular access, antimicrobial adverse events.
    • Elderly patients receiving home-based OPAT: consider cognition, mobility, and dexterity, provide treatment team access, as necessary.
    • Treat infants
  • Patients with no prior antimicrobial allergy: administer first dose at home under health care personnel supervision.
  • Midline catheters are appropriate for short (
  • Either central catheter or noncentral catheter is acceptable for vancomycin-based OPAT.
  • Tunneled central venous catheter is recommended for patients with advanced chronic kidney disease.
  • Symptomatic catheter-associated venous thromboembolism with controlled arm pain/swelling: 1) well-positioned venous catheters can remain in place, 2) prophylactic oral anticoagulants are unnecessary.
  • Peripherally inserted catheters recommended for most children.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit