- 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).
- 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.