The ASAT offers a web-enabled, version-controlled instrument for the assessment of antimicrobial stewardship in acute hospitals. It may offer a sensitive instrument to assess longitudinal progress on antimicrobial stewardship in an individual institution or act as a benchmark with similar organizations. Further work is ongoing to evaluate and further refine the ASAT.

This review found no published studies that comply with UK national standards for stability testing. We recommend further research and publication of antimicrobial stability data to support OPAT within the antimicrobial stewardship agenda.

What is already known on this subject ► Flucloxacillin is a narrow-spectrum Grampositive antibiotic used for a number of serious infections in hospital including Staphylococcus aureus bacteraemia, skin and soft tissue infection, endocarditis and osteomyelitis. ► The frequency of dosing required for flucloxacillin to maintain therapeutic efficacy renders it unsuitable for most outpatient parenteral antimicrobial therapy (OPAT) services and there is a need for data on flucloxacillin stability in extended infusions to suit OPAT services. ► Flucloxacillin degrades rapidly in aqueous solutions during extended storage without chemical stabilisation. What this study adds ► The study presents data on the use of a citrate buffer to stabilise solutions of flucloxacillin (at concentrations 10-50 mg/mL) for up to 14 days at 2°C-8°C plus 24 hours at 32°C when reconstituted and diluted in a 0.3% w/v citratebuffered saline diluent with storage in two ambulatory device reservoirs (Accufuser and INfusor L). ► These data will support the use of extended infusions of flucloxacillin in OPAT services.

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