Abstract:

Introduction: Outpatient parenteral antimicrobial therapy (OPAT) is safe and effective for selected patients managed within an organised clinical service. Service configurations however are evolving, patient populations are changing and new evidence is emerging which challenges traditional OPAT practice.

Areas covered: This review will discuss evolving OPAT service delivery from the traditional model of infusion centre towards non-specialist, community and remotely delivered OPAT and the challenges this represents. We consider new patient populations including those with incurable infection or infections at the end of life and difficult to reach populations including people who inject drugs. The evidence base that underpins the multi-disciplinary approach to OPAT delivery will be examined and particularly the role of the antimicrobial pharmacist and specialist nurse. Evidence for new treatment options which challenge established OPAT practice including complex oral antibiotic regimens, long acting parenteral agents and drug stability in continuous infusion antibiotics will be considered. Finally we emphasise the central importance of antimicrobial stewardship and good clinical governance which should underpin OPAT practice.

Expert opinion: Changing patient populations, service structures and team roles coupled with a growing infection management evidence base means that OPAT services and practice must evolve. Challenging traditional practice is essential to ensure best patient outcomes and cost-efficiency.

Reference:

Farmer ECW, Seaton RA. Recent innovations and new applications of outpatient parenteral antimicrobial therapy [published online ahead of print, 2020 Aug 17]. Expert Rev Anti Infect Ther. 2020;10.1080/14787210.2020.1810566. doi:10.1080/14787210.2020.1810566