Medicine:Outpatient parenteral antibiotic therapy
| Outpatient parenteral antibiotic therapy | |
|---|---|
| Other names | OPAT |
Clinical practice
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] In a six-year real-world retrospective study conducted at an Italian tertiary-care center, OPAT allowed a relative cost reduction of about 92% and an average daily cost of €32 for OPAT versus €400 for inpatient therapy.[3] 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.[4][5]
Subcutaneous antibiotic therapy
Although OPAT is traditionally based on intravenous administration, the subcutaneous route has emerged as a pragmatic alternative in selected clinical settings. Several antibiotics, including β-lactams (most commonly ceftriaxone) and glycopeptides (teicoplanin), are administered subcutaneously (off-label) in outpatient and home-care contexts. Available clinical and pharmacokinetic data suggest that subcutaneous administration may achieve adequate drug exposure and clinical effectiveness when appropriate dosing and loading strategies are applied.[6]
Common antimicrobials
Common antimicrobials used for continuous infusion are shown below:[7]
| Antibiotic | Stability at 25 °C | Diluent | Existing data in elastomeric pumps |
|---|---|---|---|
| cefepime | 24 hours | normal saline | Yes |
| ceftazidime | 48 hours | normal saline | Yes |
| clindamycin | 16 days | dextrose 5% | No |
| flucloxacillin | 24 hours | normal saline | Yes |
| fosfomycin | 24 hours | water for injection | No |
| oxacillin | 24 hours | normal saline | No |
| benzylpenicillin potassium | 24–48 hours | ringer acetate | Yes |
| benzylpenicillin sodium | 12–24 hours | normal saline | Yes |
| piperacillin/tazobactam | 24 hours | normal saline | Yes |
| vancomycin | 7 days | normal saline | Yes |
Before starting beta-lactams and vancomycin infusion, it is advisable to administer a loading dose in order to reduce time to reach target concentrations[8][9]
References
- ↑ Chapman, A. L. N. (26 March 2013). "Outpatient parenteral antimicrobial therapy". BMJ 346 (mar26 1). doi:10.1136/bmj.f1585. PMID 23532865.
- ↑ Voumard, Rachel; Gardiol, Céline; André, Pascal; Arensdorff, Lyne; Cochet, Camille; Boillat-Blanco, Noémie; Decosterd, Laurent; Buclin, Thierry et al. (2018-09-01). "Efficacy and safety of continuous infusions with elastomeric pumps for outpatient parenteral antimicrobial therapy (OPAT): an observational study" (in en). Journal of Antimicrobial Chemotherapy 73 (9): 2540–2545. doi:10.1093/jac/dky224. ISSN 0305-7453. PMID 29982449. https://academic.oup.com/jac/article/73/9/2540/5049033.
- ↑ Babich, Stella; Di Bella, Stefano; De Rivo, Raffaele; Durojaiye, Oyewole Christopher; Lovecchio, Antonio; Misin, Andrea; Straciug, Madalina; Gobbo, Ylenia et al. (2025-10-31). "Continuous infusion OPAT via elastomeric pumps: effectiveness, safety, and cost-saving potential in a real-world Italian cohort" (in en). Infection. doi:10.1007/s15010-025-02671-0. ISSN 0300-8126. PMC 12864358. https://link.springer.com/10.1007/s15010-025-02671-0.
- ↑ "Clinic- and Hospital-Based Home Care, Outpatient Parenteral Antimicrobial Therapy (OPAT) and the Evolving Clinical Responsibilities of the Pharmacist". Pharmacy 8 (4): 233. December 2020. doi:10.3390/pharmacy8040233. PMID 33297356.
- ↑ "Feasibility, Effectiveness and Safety of Elastomeric Pumps for Delivery of Antibiotics to Adult Hospital Inpatients-A Systematic Review". Antibiotics 12 (9): 1351. August 2023. doi:10.3390/antibiotics12091351. 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.".
- ↑ Di Bella, Stefano; Geremia, Nicholas; Pea, Federico; Zeitlinger, Markus; Sanson, Gianfranco; Monticelli, Jacopo; Bergmann, Felix; Motet, Christian et al. (2026-01-20). "When and How to Use Subcutaneous Antibiotics" (in en). Clinical Infectious Diseases. doi:10.1093/cid/ciaf691. ISSN 1058-4838. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaf691/8424090.
- ↑ 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" (in en). Antibiotics 9 (7): 398. doi:10.3390/antibiotics9070398. ISSN 2079-6382. PMID 32664288.
- ↑ 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" (in en). International Journal of Antimicrobial Agents 35 (2): 156–163. doi:10.1016/j.ijantimicag.2009.10.008. PMID 20018492. https://linkinghub.elsevier.com/retrieve/pii/S0924857909004828.
- ↑ Waineo, M. F.; Kuhn, T. C.; Brown, D. L. (June 2015). "The pharmacokinetic/pharmacodynamic rationale for administering vancomycin via continuous infusion" (in en). Journal of Clinical Pharmacy and Therapeutics 40 (3): 259–265. doi:10.1111/jcpt.12270. PMID 25865426.
 |  |
