Outpatient parenteral antibiotic therapy

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Outpatient parenteral antibiotic therapy
Other namesOPAT

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] 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. [3] [4]

Common antimicrobials

Common antimicrobials used for continuous infusion are shown below: [5]

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 [6] [7]

Related Research Articles

<span class="mw-page-title-main">Vancomycin</span> Antibiotic medication

Vancomycin is a glycopeptide antibiotic medication used to treat a number of bacterial infections. It is used intravenously as a treatment for complicated skin infections, bloodstream infections, endocarditis, bone and joint infections, and meningitis caused by methicillin-resistant Staphylococcus aureus. Blood levels may be measured to determine the correct dose. Vancomycin is also taken orally as a treatment for severe Clostridium difficile colitis. When taken orally it is poorly absorbed.

<span class="mw-page-title-main">Intravenous therapy</span> Medication administered into a vein

Intravenous therapy is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrients for those who cannot, or will not—due to reduced mental states or otherwise—consume food or water by mouth. It may also be used to administer medications or other medical therapy such as blood products or electrolytes to correct electrolyte imbalances. Attempts at providing intravenous therapy have been recorded as early as the 1400s, but the practice did not become widespread until the 1900s after the development of techniques for safe, effective use.

<span class="mw-page-title-main">Route of administration</span> Path by which a drug, fluid, poison, or other substance is taken into the body

In pharmacology and toxicology, a route of administration is the way by which a drug, fluid, poison, or other substance is taken into the body.

<span class="mw-page-title-main">Linezolid</span> Antibiotic medication

Linezolid is an antibiotic used for the treatment of infections caused by Gram-positive bacteria that are resistant to other antibiotics. Linezolid is active against most Gram-positive bacteria that cause disease, including streptococci, vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA). The main uses are infections of the skin and pneumonia although it may be used for a variety of other infections including drug-resistant tuberculosis. It is used either by injection into a vein or by mouth.

<span class="mw-page-title-main">Meropenem</span> Broad-spectrum antibiotic

Meropenem, sold under the brand name Merrem among others, is an intravenous carbapenem antibiotic used to treat a variety of bacterial infections. Some of these include meningitis, intra-abdominal infection, pneumonia, sepsis, and anthrax.

<span class="mw-page-title-main">Piperacillin</span> Antibiotic medication

Piperacillin is a broad-spectrum β-lactam antibiotic of the ureidopenicillin class. The chemical structure of piperacillin and other ureidopenicillins incorporates a polar side chain that enhances penetration into Gram-negative bacteria and reduces susceptibility to cleavage by Gram-negative beta lactamase enzymes. These properties confer activity against the important hospital pathogen Pseudomonas aeruginosa. Thus piperacillin is sometimes referred to as an "anti-pseudomonal penicillin".

<span class="mw-page-title-main">Tigecycline</span> Chemical compound

Tigecycline, sold under the brand name Tygacil, is a tetracycline antibiotic medication for a number of bacterial infections. It is a glycylcycline class drug that is administered intravenously. It was developed in response to the growing rate of antibiotic resistant bacteria such as Staphylococcus aureus, Acinetobacter baumannii, and E. coli. As a tetracycline derivative antibiotic, its structural modifications has expanded its therapeutic activity to include Gram-positive and Gram-negative organisms, including those of multi-drug resistance.

<span class="mw-page-title-main">Infusion pump</span> Medical device

An infusion pump infuses fluids, medication or nutrients into a patient's circulatory system. It is generally used intravenously, although subcutaneous, arterial and epidural infusions are occasionally used.

<span class="mw-page-title-main">Temocillin</span> Chemical compound

Temocillin is a β-lactamase-resistant penicillin introduced by Beecham, marketed by Eumedica Pharmaceuticals as Negaban. It is used primarily for the treatment of multiple drug-resistant, Gram-negative bacteria.
It is a 6-methoxy penicillin; it is also a carboxypenicillin.

<span class="mw-page-title-main">Estramustine phosphate</span> Chemical compound

Estramustine phosphate (EMP), also known as estradiol normustine phosphate and sold under the brand names Emcyt and Estracyt, is a dual estrogen and chemotherapy medication which is used in the treatment of prostate cancer in men. It is taken multiple times a day by mouth or by injection into a vein.

A drug of last resort (DoLR), also known as a heroic dose, is a pharmaceutical drug which is tried after all other drug options have failed to produce an adequate response in the patient. Drug resistance, such as antimicrobial resistance or antineoplastic resistance, may make the first-line drug ineffective, especially in case of multidrug-resistant pathogens and tumors. Such an alternative may be outside of extant regulatory requirements or medical best practices, in which case it may be viewed as salvage therapy.

<span class="mw-page-title-main">Oritavancin</span> Pharmaceutical drug

Oritavancin, sold under the brand name Orbactiv among others, is a semisynthetic glycopeptide antibiotic medication for the treatment of serious Gram-positive bacterial infections. Its chemical structure as a lipoglycopeptide is similar to vancomycin.

<span class="mw-page-title-main">Fosfomycin</span> Chemical compound

Fosfomycin, sold under the brand name Monurol among others, is an antibiotic primarily used to treat lower urinary tract infections. It is not indicated for kidney infections. Occasionally it is used for prostate infections. It is generally taken by mouth.

<span class="mw-page-title-main">Infusion therapy</span> Medical aspects of fluid and medication infusion by therapeutic application

In medicine, infusion therapy deals with all aspects of fluid and medication infusion, via intravenous or subcutaneous application. A special infusion pump can be used for this purpose.

<span class="mw-page-title-main">Taurolidine</span> Antimicrobial compound

Taurolidine is an antimicrobial that is used to prevent infections in catheters. Side effects and the induction of bacterial resistance is uncommon. It is also being studied as a treatment for cancer.

<span class="mw-page-title-main">Ceftaroline fosamil</span> Chemical compound

Ceftaroline fosamil (INN), brand name Teflaro in the US and Zinforo in Europe, is a cephalosporin antibiotic with anti-MRSA activity. Ceftaroline fosamil is a prodrug of ceftaroline. It is active against methicillin-resistant Staphylococcus aureus (MRSA) and other Gram-positive bacteria. It retains some activity of later-generation cephalosporins having broad-spectrum activity against Gram-negative bacteria, but its effectiveness is relatively much weaker. It is currently being investigated for community-acquired pneumonia and complicated skin and skin structure infection.

<span class="mw-page-title-main">Elastomeric pump</span>

Elastomeric pumps, also called balloon pumps or ball pumps, are usually used in the medical field to administer liquid drugs such as local anesthetics, analgesics, cytostatics or antibiotics.

<span class="mw-page-title-main">Nemonoxacin</span> Chemical compound

Nemonoxacin is a non-fluorinated quinolone antibiotic undergoing clinical trials. It has the same mechanism of action as fluouroquinolones; it inhibits DNA gyrase, preventing DNA synthesis, gene duplication, and cell division. At the end of 2016, it had reached market in Taiwan, Russia, the Commonwealth Independent States, Turkey, mainland China, and Latin America under the brand name Taigexyn. Nemonoxacin has completed phase 2 trials in the US and has moved on to phase 3 trials. The U.S. Food and Drug Administration (FDA) has granted nemonoxacin qualified infectious disease product (QIDP) and fast track designations for community-acquired bacterial pneumonia (CAP) and acute bacterial skin and skin-structure infections (ABSSSI).

<span class="mw-page-title-main">British Society for Antimicrobial Chemotherapy</span> British-based academic scientific society

The British Society for Antimicrobial Chemotherapy (BSAC) is a UK-based multi-professional organisation committed to preventing infectious diseases and tackling the growing threat of drug-resistant infections – one of the one of the top global public health and development threats.

Kerry L. LaPlante is an American pharmacist, academic and researcher. She is the Dean at the University of Rhode Island College of Pharmacy. She is a Professor of Pharmacy and former department Chair of the Department of Pharmacy Practice at the University of Rhode Island, an Adjunct Professor of Medicine at Brown University, an Infectious Diseases Pharmacotherapy Specialist, and the Director of the Rhode Island Infectious Diseases Fellowship and Research Programs at the Veterans Affairs Medical Center in Providence, Rhode Island.

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. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.