Outpatient parenteral antimicrobial therapy

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1585 (Published 26 March 2013)
Cite this as: BMJ 2013;346:f1585

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  1. Ann L N Chapman, consultant in infectious diseases
  1. 1Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundations Trust, Sheffield S10 2JF, UK
  1. ann.chapman{at}sth.nhs.uk
  • Accepted 20 February 2013

Summary points

  • Outpatient parenteral antimicrobial therapy (OPAT) allows patients requiring intravenous antibiotics to be treated outside hospital

  • OPAT is suitable for many infections, especially cellulitis, bone and joint infections, and infective endocarditis

  • Antibiotics can be administered in an outpatient unit, at home by a nurse, or at home by the patient or a carer

  • Patients should be assessed by a doctor and specialist nurse to determine medical and social suitability

  • Evidence suggests that OPAT is safe as long as it is administered through a formal service structure to minimise risk

Outpatient parenteral antimicrobial therapy (OPAT) allows patients to be given intravenous antibiotics in the community rather than as an inpatient. First developed in the 1970s in the US for the treatment of children with cystic fibrosis,1 OPAT has expanded substantially and is now standard practice in many countries.2 3 In the UK, uptake has been much slower, although OPAT is now being increasingly used in both primary and secondary care, driven by a national focus on efficiency savings in healthcare, improving patient experience, and provision of care closer to home. It is important that medical practitioners are aware both of the opportunities that OPAT presents and of the potential risks of treatment outside hospital for patients with serious and often complex infections. This article aims to describe the clinical practice of OPAT, highlight potential risks, and explore how these may be reduced.

What is OPAT?

OPAT is the administration of intravenous antimicrobial therapy to patients in an outpatient setting or in their own home. It can be used for patients with severe or deep seated infections who require parenteral treatment but are otherwise stable and well enough not to be in hospital; these patients may be discharged early to an OPAT service or may avoid hospital admission altogether.

What type of infections can be treated?

Cellulitis

OPAT is most widely used …

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