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Published on: April 9, 2013
Outpatient parenteral antibiotic therapy: principles and practice
1Brownlee Centre for Infectious Diseases, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, United Kingdom.
European Journal of Internal Medicine
|April 23, 2013
Summary
Outpatient parenteral antimicrobial therapy (OPAT) enables hospital admission avoidance and early discharge. Internal medicine specialists are crucial for developing and delivering OPAT services, improving patient welfare and resource use.
Area of Science:
- Infectious Diseases
- Internal Medicine
- Ambulatory Care
Background:
- Outpatient parenteral antimicrobial therapy (OPAT) is administered in non-hospital settings to avoid admissions or enable early discharge.
- While traditionally managed by infection specialists, internal medicine plays a vital role in OPAT service development and integration with 'hospital at home' initiatives.
Purpose of the Study:
- To highlight the key role of internal medicine specialists in OPAT.
- To discuss the drivers, principles, and practical application of OPAT.
- To present clinical experience from the UK in managing OPAT.
Main Methods:
- Review of OPAT principles and drivers.
- Discussion of patient selection and antimicrobial management strategies.
- Presentation of UK clinical experience.
Main Results:
- OPAT is driven by patient welfare, reduced healthcare-associated infections, and cost-effective resource utilization.
- Gram-positive infections are common indications for OPAT, with increasing importance of resistant Gram-negative infections.
- Certain antimicrobials (ceftriaxone, teicoplanin, daptomycin, ertapenem) are well-suited for OPAT due to administration frequency.
Conclusions:
- Safe OPAT requires a multidisciplinary team, careful patient selection, and robust monitoring.
- Internal medicine specialists are essential for the future development of OPAT, especially with complex patients and resource limitations.
- OPAT is a key component of modern ambulatory care and 'hospital at home' strategies.
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