Outpatient Parenteral Antimicrobial Therapy (OPAT) Guidelines: A Systematic Review

To guarantee the safe and effective provision of Outpatient Parenteral Antimicrobial Therapy (OPAT), appropriate practice guidelines are essential for offering the necessary recommendations. This study aims to synthesise and appraise published OPAT clinical practice guidelines.

Bibliographic databases were systematically searched for OPAT guidelines from inception to 14 July 2026, complemented by hand-searching. All guidelines in English were included. Reporting and methodological quality were evaluated using the RIGHT and AGREE II tools. Correlations between AGREE II and RIGHT domain scores were investigated using Spearman's correlation. Inter-rater agreement was assessed using intraclass correlation coefficients estimated with a two-way random effects model.

Seven guidelines met the eligibility criteria. Almost all guidelines were published or revised within the last ten years, with the earliest one release in 2004 and the most recent one was published in 2026. Most guidelines aimed to standardise the delivery, safety, and effectiveness of OPAT in their respective healthcare settings. The average overall score for methodological quality of the guidelines from AGREE II was 81.0% while the average overall reporting quality score of the guidelines using the RIGHT instrument was 61.6%. There was an overall positive correlation between AGREE II and RIGHT domain scores.

The OPAT guidelines have substantial heterogeneity in methodological quality and reporting completeness. While clear clinical recommendations were noted, lack of evidence syntheses methods and quality assurance were identified. Robust and transparent OPAT guidelines are critical to ensure safe, sustainable, and equitable expansion of outpatient antimicrobial care worldwide.