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Updated UK good practice recommendations for outpatient parenteral antimicrobial therapy

Updated good practice recommendations (GPRs) for outpatient parenteral antimicrobial therapy (OPAT) in adults and children in the UK have been published in JAC - Antimicrobial Resistance, the journal of the British Society for Antimicrobial Chemotherapy (BSAC).

UK GPRs for OPAT were previously published in 2012 and 2015 for adult and paediatric patients, respectively. This update combines both adult and paediatric OPAT in recognition that the principles of safe and effective OPAT are the same in these two groups.

When considering the OPAT team, there is a recognition in the new update that competence in different aspects of delivering OPAT is not restricted by job title.

In patient selection, the literature review highlighted a move away from using rigid selection criteria relating to infection parameters and social factors to a more individualised approach incorporating consideration of comorbidities and recognition that different patient groups may be better/less suited to specific antibiotics and/or specific delivery models.

With increasing use of continuous infusion devices, the update team notes there is a need for robust data on the stability of antimicrobial agents, particularly in ‘real-life’ situations where the device may be maintained near body temperature for prolonged periods. These GPRs set the required standard for stability testing at a high level - that of the BSAC Drug Stability Testing Programm, and recommends working towards obtaining this level of robust data for a wider range of antimicrobial agents.

In terms of monitoring during OPAT, the requirement for weekly blood tests in patients on prolonged OPAT courses is an evidence-based change from the previous recommendations.

Finally, there is recognition that OPAT may be used in situations where the anticipated outcome is not cure of infection; particularly with increasing use of prosthetic devices in orthopaedics or vascular surgery and use of OPAT for suppression of infection or palliation.


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