All patients commencing outpatient parenteral antimicrobial therapy (OPAT) should have their treatment reviewed by an infectious diseases specialist before initiation and be monitored regularly, recommends updated OPAT guidelines from the Infectious Diseases Society of America (IDSA).
The guidelines, published in the journal Clinical Infectious Diseases, also recommend that:
- OPAT vancomycin should be monitored closely throughout the course of treatment for adverse events.
- In patients with no history of allergy to antimicrobials in the same class, the first dose of a new IV antimicrobial may be given at home under the supervision of healthcare personnel qualified and equipped to respond to anaphylactic reactions.
- In patients receiving OPAT antimicrobials for two weeks or less, it is acceptable to use a midline catheter in the arm rather than via a peripherally inserted central catheter (PICC) or central venous catheter.
"The majority of patients referred for OPAT therapy do need it, but in many cases an oral antimicrobial would do the job. Given the growing worldwide problem with antimicrobial overuse and resistance, any opportunity to de-escalate these drugs is critically important," said Dr Anne H. Norris, guidelines co-chair. “Not only does this provide good stewardship of antimicrobials, but lowers costs and potentially improves patients' wellbeing.”