[Outpatient parenteral antibiotic treatment: the Italian model]

Though constrained by the lack of standard criteria for patient selection and well defined therapeutic protocols, the Italian model of OPAT is characterized by the home treatment of infections also of moderate severity, chiefly of the lower respiratory tract by means of broad spectrum antibiotics (chiefly beta-lactams) administered intramuscularly. The selection of patient for OPAT remains an individual decision of GPs based on the severity of infection, concomitant diseases, age of the patient, reliability of patients and family, environ- mental and social factors. Such a model has gained broad consensus over the years from patients for different cultural reasons: first, the willingness of patients to participate in the OPAT programmes, second, the concept that home is better than hospital even when you are ill and, third, the fact that parenteral drugs are perceived as more effective than oral ones, probably in contrast with the culture and traditions of other countries (especially northern Europe) where hospitals are still considered the only proper site of care and intramuscular administration is regarded as almost unnatural. No private or insurance reimbursement based OPAT structure exists up to now in Italy or is go. ing to be developed. The main problems in Italy now seems to be: -to define clear protocols and easy criteria for selection of patients enable to OPAT, -to improve what existing by creating and/or qualifying new professionals involved with in- and outpatients (OPAT, early discharge,medical care for special populations.).