Limited role for outpatient parenteral antibiotic therapy for community-acquired pneumonia

This study examined the potential utility of outpatient parenteral antibiotic therapy (OPAT) as a means of reducing the excessive number of patients hospitalized with low-risk community-acquired pneumonia (CAP).

A prospective feasibility study was conducted, in which a selection algorithm was applied to a cohort of patients admitted with suspected CAP, to identify a group in whom admission may have been prevented by the use of OPAT. Numbers of potentially suitable patients, inpatient bed days saved and frequency of adverse events that may have led to readmission were measured.

There were 118 inpatients treated with confirmed CAP during the study period, of whom 27 had low-risk disease (Pneumonia Severity Index grades I-III). Application of the selection algorithm identified eight (30% of those with low-risk disease) patients who were potentially suitable for OPAT, and this group commonly experienced adverse events during follow up which may have resulted in readmission to hospital.

In many hospitalized patients with CAP, outpatient therapy is precluded by either disease severity or active medical and psychosocial factors. This limits the role of OPAT as a tool for reducing the inpatient burden of CAP.