Management of Outpatient Parenteral Antimicrobial Therapy
Publication Date: November 12, 2018
Last Updated: December 15, 2022
Treatment
Patient Considerations
Patients (or their caregivers) should be allowed to self-administer OPAT. ( S , L)
705
Patients (or their caregivers) may be allowed to self-administer OPAT at home without visiting nurse support as long as there is a system in place for effective monitoring for vascular access complications and antimicrobial adverse events. ( W , L)
705
No recommendation can be made about whether PWID may be treated with OPAT at home. (, L)
Decisions should be made on a case by case basis.
705
Elderly patients should be allowed to be treated with OPAT at home. ( S , L)
This recommendation assumes that potential challenges to OPAT in the elderly, such as cognition, mobility, dexterity, have been duly considered, and that the patient or caregiver is able to communicate with the treatment team if necessary.
705
No recommendation can be made regarding whether infants <1 month old may be treated with OPAT at home. (, VL)
705
Antimicrobial and Catheter Utilization
In patients with no prior history of allergy to antimicrobials in the same class, the first dose of a new parenteral antimicrobial may be administered at home under the supervision of healthcare personnel who are qualified and equipped to respond to anaphylactic reactions. ( W , VL)
705
In adult patients needing short courses of OPAT (less than 14 days), a MC rather may be used rather than a central catheter . ( W , VL)
No recommendations can be made regarding the use of MCs in pediatric patients.
705
Mandatory use of a central catheter over a non-central catheter for OPAT with vancomycin is not necessary. ( W , VL)
705
No recommendation can be made for choice of vascular catheter for OPAT with other vesicant antimicrobials such as nafcillin and acyclovir. (, VL)
705
For patients with advanced CKD requiring OPAT, t-CVC are recommended rather than PICCs. ( S , L)
705
No recommendation can be made about whether patients who require frequent courses of OPAT should have a long-term central catheter left in place between courses. (, )
705
It is not necessary to remove a vascular access device if CA-VTE develops during OPAT, as long as the catheter remains well-positioned and arm pain and swelling decrease with anticoagulation. ( W , VL)
705
No recommendation can be made regarding the need to treat patients with a history of prior CA-VTE with prophylactic oral anticoagulation while on OPAT. (, )
705
For most children requiring OPAT, PICCs should be placed rather than LTCCs. ( S , VL)
705
Monitoring
Serial laboratory testing should be monitored in patients receiving OPAT (S, H)
- Data are insufficient to make evidence-based recommendations about specific tests and specific frequencies of monitoring for individual antimicrobials used in OPAT.
705
Vancomycin blood levels should be measured regularly throughout the course of OPAT treatment . (S, VL)
- The optimal frequency of measurement is undefined, but the general practice, in the setting of stable renal function, is once weekly.
705
No generalized recommendation on frequency of outpatient follow-up can be made for patients treated with OPAT. (, )
- The frequency of office visits should be dictated by the treating physician, giving consideration to patient characteristics, the nature of the infection, the patient’s tolerance of and response to therapy, and individual patient social factors.
705
Antimicrobial Stewardship
All patients should have infectious disease expert review prior to initiation of OPAT. (S, VL)
705
Title
Management of Outpatient Parenteral Antimicrobial Therapy
Authoring Organization
Infectious Diseases Society of America
Publication Month/Year
November 12, 2018
Last Updated Month/Year
June 12, 2023
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Infant, Older adult
Health Care Settings
Ambulatory, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management, Treatment
Keywords
parenteral antimicrobial therapy, OPAT, IV antimicrobial
Source Citation
Anne H Norris, Nabin K Shrestha, Genève M Allison, Sara C Keller, Kavita P Bhavan, John J Zurlo, Adam L Hersh, Lisa A Gorski, John A Bosso, Mobeen H Rathore, Antonio Arrieta, Russell M Petrak, Akshay Shah, Richard B Brown, Shandra L Knight, Craig A Umscheid, 2018 Infectious Diseases Society of America Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapy, Clinical Infectious Diseases, Volume 68, Issue 1, 1 January 2019, Pages e1–e35, https://doi.org/10.1093/cid/ciy745
Methodology
Number of Source Documents
153
Literature Search Start Date
October 28, 2015
Literature Search End Date
January 31, 2017