IDSA revises guidelines on outpatient parenteral antimicrobial therapy

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

  • curated by Liz Scherer
  • Clinical Essentials
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  • 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.

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