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Practice Guidelines for Outpatient Parenteral Antimicrobial Therapy

Tice, A., S. Rehm, J. Dalovisio, J. Bradley, L. Martinelli, D. Graham, R. Gainer, M. Kunkel, R. Yancey, and D. Williams. (2004). Practice Guidelines for Outpatient Parenteral Antimicrobial Therapy. Idsa Guidelines. Clin Infect Dis, 38(12):1651-72. Executive Summary: These guidelines were formulated to assist physicians and other health care professionals with various aspects of the administration of outpatient parenteral antimicrobial therapy (OPAT). Although there are many reassuring retrospective studies on the efficacy and safety of OPAT, few prospective studies have been conducted to compare the risks and outcomes for patients who receive treatment as outpatients rather than as inpatients. Because truly evidence-based studies are lacking, the present guidelines are formulated from the collective experience of the committee members and advisors from related organizations. Important aspects of OPAT are described in the text and tables and include the following:

  1. The literature supports the effectiveness of OPAT for a wide variety of infections (table 1 and theAppendix).
  2. A thorough assessment of the patient’s general medical condition, the infectious process, and the home situation is necessary before starting therapy (table 2)
  3. Prescribing physicians should be aware of a number of aspects of OPAT which distinguish it from other forms of therapy. These include the required teamwork, communication, monitoring, and outcome measurements (tables 3 and 4).
  4. The physician has a unique role on the OPAT team, which may also include nursing, pharmacy, and social services. These responsibilities include establishing a diagnosis, prescribing treatment, determining the appropriate site of care,  monitoring during therapy, and assuring the overall quality of care.
  5. Antimicrobial selection for OPAT is different from that for therapy in the hospital. Once-daily drug administration has many advantages. Potential for adverse effects and the stability of an antimicrobial once it is mixed must be considered (tables 5–7).
  6. The importance of administering the first dose of an antibiotic in a supervised setting is emphasized.
  7. Regular clinical and laboratory monitoring of patients receiving OPAT is essential and varies with the antimicrobial chosen (table 8).
  8. Outcomes measures should be an integral part of any OPAT program, to assure the effectiveness and quality of care (table 9).
  9. Children receiving OPAT must be considered differently because of their special needs.
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