Management of Outpatient Parenteral Antimicrobial Therapy

Publication Date: November 12, 2018

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

Recommendation Grading

Disclaimer

Overview

Title

Management of Outpatient Parenteral Antimicrobial Therapy

Authoring Organization

Publication Month/Year

November 12, 2018

Supplemental Implementation Tools

Document Type

Guideline

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