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Outpatient parenteral antibiotic therapy

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Outpatient parenteral antibiotic therapy
Other namesOPAT

Clinical practice

Outpatient parenteral antibiotic therapy (OPAT) is used to administer non-oral antibiotics (usually intravenously) without the need for ongoing hospitalisation. OPAT is particularly useful for people who are not severely ill but do require a prolonged course of treatment that cannot be given in oral form. [1] OPAT is being increasingly adopted as part of antimicrobial stewardship programs; it can reduce length of stay, costs and adverse events while improving quality of life. [2] In a six-year real-world retrospective study conducted at an Italian tertiary-care center, OPAT allowed a relative cost reduction of about 92% and an average daily cost of €32 for OPAT versus €400 for inpatient therapy. [3] OPAT can be administered in an outpatient facility (including a provider's office, infusion center or day hospital) or at a patient's residence using an infusion pump, such as an elastomeric pump. [4] [5]

Contents

Subcutaneous antibiotic therapy

Although OPAT is traditionally based on intravenous administration, the subcutaneous route has emerged as a pragmatic alternative in selected clinical settings. Several antibiotics, including β-lactams (most commonly ceftriaxone) and glycopeptides (teicoplanin), are administered subcutaneously (off-label) in outpatient and home-care contexts. Available clinical and pharmacokinetic data suggest that subcutaneous administration may achieve adequate drug exposure and clinical effectiveness when appropriate dosing and loading strategies are applied. [6]

Common antimicrobials

Common antimicrobials used for continuous infusion are shown below: [7]

AntibioticStability at 25 °CDiluentExisting data in elastomeric pumps
cefepime24 hoursnormal salineYes
ceftazidime48 hoursnormal salineYes
clindamycin16 daysdextrose 5%No
flucloxacillin24 hoursnormal salineYes
fosfomycin24 hourswater for injectionNo
oxacillin24 hoursnormal salineNo
benzylpenicillin potassium24–48 hoursringer acetateYes
benzylpenicillin sodium12–24 hoursnormal salineYes
piperacillin/tazobactam24 hoursnormal salineYes
vancomycin7 daysnormal salineYes

Before starting beta-lactams and vancomycin infusion, it is advisable to administer a loading dose in order to reduce time to reach target concentrations [8] [9]

References

  1. ↑ Chapman, A. L. N. (26 March 2013). "Outpatient parenteral antimicrobial therapy". BMJ. 346 (mar26 1) f1585. doi:10.1136/bmj.f1585. PMID   23532865. S2CID   38761363.
  2. ↑ Voumard, Rachel; Gardiol, Céline; André, Pascal; Arensdorff, Lyne; Cochet, Camille; Boillat-Blanco, Noémie; Decosterd, Laurent; Buclin, Thierry; de Vallière, Serge (2018-09-01). "Efficacy and safety of continuous infusions with elastomeric pumps for outpatient parenteral antimicrobial therapy (OPAT): an observational study". Journal of Antimicrobial Chemotherapy. 73 (9): 2540–2545. doi:10.1093/jac/dky224. ISSN   0305-7453. PMID   29982449.
  3. ↑ Babich, Stella; Di Bella, Stefano; De Rivo, Raffaele; Durojaiye, Oyewole Christopher; Lovecchio, Antonio; Misin, Andrea; Straciug, Madalina; Gobbo, Ylenia; Dellaluce, Angela; Palmolungo, Michela; Fabricci, Massimiliano; Di Girolamo, Filippo Giorgio; Roni, Chiara; Monticelli, Jacopo (2025-10-31). "Continuous infusion OPAT via elastomeric pumps: effectiveness, safety, and cost-saving potential in a real-world Italian cohort". Infection. doi: 10.1007/s15010-025-02671-0 . ISSN   0300-8126.
  4. ↑ Docherty T, Schneider JJ, Cooper J (December 2020). "Clinic- and Hospital-Based Home Care, Outpatient Parenteral Antimicrobial Therapy (OPAT) and the Evolving Clinical Responsibilities of the Pharmacist". Pharmacy. 8 (4): 233. doi: 10.3390/pharmacy8040233 . PMC   7768382 . PMID   33297356.
  5. ↑ Spencer-Jones J, Luxton T, Bond SE, Sandoe J (August 2023). "Feasibility, Effectiveness and Safety of Elastomeric Pumps for Delivery of Antibiotics to Adult Hospital Inpatients-A Systematic Review". Antibiotics. 12 (9): 1351. doi: 10.3390/antibiotics12091351 . PMC   10525832 . PMID   37760648. Elastomeric infusion pumps (EMPs) have been implemented in many fields, including analgesia, chemotherapy and cardiology. Their application in antimicrobials is mainly limited to the outpatient setting, but with a need to optimise inpatient antimicrobial treatment, the use of EMPs presents a potential option.
  6. ↑ Di Bella, Stefano; Geremia, Nicholas; Pea, Federico; Zeitlinger, Markus; Sanson, Gianfranco; Monticelli, Jacopo; Bergmann, Felix; Motet, Christian; Lambotte-Buffet, Christophe; Zerbato, Verena; Gatti, Milo (2026-01-20). "When and How to Use Subcutaneous Antibiotics". Clinical Infectious Diseases. doi:10.1093/cid/ciaf691. ISSN   1058-4838.
  7. ↑ Di Bella, Stefano; Beović, Bojana; Fabbiani, Massimiliano; Valentini, Michael; Luzzati, Roberto (2020-07-10). "Antimicrobial Stewardship: From Bedside to Theory. Thirteen Examples of Old and More Recent Strategies from Everyday Clinical Practice". Antibiotics. 9 (7): 398. doi: 10.3390/antibiotics9070398 . ISSN   2079-6382. PMC   7399849 . PMID   32664288.
  8. ↑ Roberts, Jason A.; Kirkpatrick, Carl M.J.; Roberts, Michael S.; Dalley, Andrew J.; Lipman, Jeffrey (February 2010). "First-dose and steady-state population pharmacokinetics and pharmacodynamics of piperacillin by continuous or intermittent dosing in critically ill patients with sepsis" . International Journal of Antimicrobial Agents. 35 (2): 156–163. doi:10.1016/j.ijantimicag.2009.10.008. PMID   20018492.
  9. ↑ Waineo, M. F.; Kuhn, T. C.; Brown, D. L. (June 2015). "The pharmacokinetic/pharmacodynamic rationale for administering vancomycin via continuous infusion". Journal of Clinical Pharmacy and Therapeutics. 40 (3): 259–265. doi: 10.1111/jcpt.12270 . PMID   25865426.


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