Updated guidelines advise on outpatient parenteral antimicrobial therapy

An infectious disease specialist should be consulted before receiving intravenous (IV) antimicrobial infusion therapy outside of the hospital, suggesting updated guidelines published by the Insiders Diseases Society of America (IDSA). ) and published in the newspaper Clinical Infectious Diseases. Once they begin receiving outpatient parenteral antimicrobial (OPAT) treatment, patients should be monitored regularly as directed.

Since the publication of previous guidelines in 2004, large studies have concluded that there is no difference between the number of adverse events associated with OPAT and the intravenous antimicrobial therapy administered at the time of treatment. hospital. In addition, recently published research emphasizes the importance of a physician, nurse or pharmacist's examination before beginning OPAT, pointing out that this is associated with a lower risk of readmission to the physician. hospital. In many cases, a specialist will recommend the use of an oral antimicrobial instead of an intravenous antimicrobial. A study concluded that a management program led by an identification specialist was able to reduce pediatric OPAT orders by 24% without increasing the number of readmissions.

The other recommendations in the guideline are:

• Vancomycin OPAT should be closely monitored throughout treatment for adverse effects, as one study found that 42% of patients developed nephrotoxicity after 14 days of treatment. If nephrotoxicity develops, one of the options is to reduce the dose or stop vancomycin and switch to another drug such as daptomycin.
• In patients with no history of allergy to antimicrobials of the same class, the first dose of a new intravenous antimicrobial can be administered at home under the supervision of a trained health worker to the management of an allergic reaction.
• In patients receiving OPAT antimicrobials for 2 weeks or less, it is acceptable to administer the drug with the aid of a medial catheter in the arm rather than via a central catheter inserted at the periphery ( PICC) or a central venous catheter.
• If a patient with PICC develops a blood clot, it is not necessary to remove and replace the catheter if anticoagulation is started, the catheter is well positioned and the pain and swelling of the arm has decreased.

"Given the growing problem of excessive use and antimicrobial resistance around the world, any possibility of defusing these drugs is of paramount importance," Anne H. Norris, MD, director of guidelines and associate professor of clinical medicine at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia said in a press release on the guidelines. "Not only that [guideline] ensure good antimicrobial stewardship, but reduce costs and potentially improve the well-being of patients. It is always best to avoid intravenous access where possible, and narrower spectrum antimicrobials kill less healthy bacteria than larger spectrum agents. "

References
1. Norris AH, Shrestha NN, GM Allisoin, et al. IDSA 2018 Clinical Practice Guide for the Management of Outpatient Parenteral Antimicrobial Therapy. Clin Infect Dis. 2018; https://doi.org/10.1093/cid/ciy745.

2. The contribution of an identification specialist improves the results of outpatient parenteral antimicrobial therapy [news release]. Arlington, Virginia. IDSA website. https://www.idsociety.org/news–publications-new/articles/2018/id-specialist-input-improves-outcomes-for–outpatient-parenteral-antimicrobial-therapy-new-idsa-guidelines/ Accessed November 13, 2018.