Outpatient parenteral antibiotic therapy (OPAT) in Asia: missing an opportunity

Fisher, Dale; Michaels, Jessica; Hase, Ryota; Zhang, Jing; Kataria, Sushila; Sim, Benedict Lh; Tsang, Joseph Kay Yan; Pollard, James; Chan, Mónica; Swaminathan, Subramanian

doi:10.1093/jac/dkw551

Cited by 9 publications

(14 citation statements)

References 22 publications

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“…Re-admission to hospital was due to worsening of their underlying comorbidities or for elective surgical procedures. Six patients had treatment ceased early, these were based on clinical responses to treatment and is similar to the rate reported in previous OPAT studies (Fisher et al, 2017).…”

Section: Antibiotics In An Outpatient Settingsupporting

confidence: 75%

“…It is a cost-effective and safe alternative to inpatient care. Depending on the pharmacokinetic profile, antibiotics are generally administered either via 24-hour infusion devices or once-daily infusions (Fisher et al, 2017).…”

Section: Antibiotics In An Outpatient Settingmentioning

confidence: 99%

“…Patient recruitment to OPAT may be enhanced by the shorter attendance time required. Furthermore, such additions to the efficiency of administration may enable more hospitals to develop formal centralized OPAT programmes with the inherent advantages previously published (Fisher et al, 2017).…”

Section: Antibiotics In An Outpatient Settingmentioning

confidence: 99%

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Safety and efficacy of a 5-minute infusion versus the standard 30-minute infusion for antibiotics in an outpatient setting

Oon

Salada

Lim

et al. 2021

International Journal of Infectious Diseases

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Section: Antibiotics In An Outpatient Settingsupporting

confidence: 75%

Section: Antibiotics In An Outpatient Settingmentioning

confidence: 99%

See 1 more Smart Citation

Safety and efficacy of a 5-minute infusion versus the standard 30-minute infusion for antibiotics in an outpatient setting

Oon

Salada

Lim

et al. 2021

International Journal of Infectious Diseases

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“…In the absence of suitable oral options, availability of dedicated OPAT services could shorten the hospital stay in these patients. However, OPAT services are not widely available in most Asian countries including India [ 52 ]. At least in some of our trial participants who had infections caused by ciprofloxacin-susceptible organisms, the treatment could have been switched to oral FQs.…”

Section: Discussionmentioning

confidence: 99%

Stopping the effective non-fluoroquinolone antibiotics at day 7 vs continuing until day 14 in adults with acute pyelonephritis requiring hospitalization: A randomized non-inferiority trial

et al. 2018

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ObjectiveTo evaluate whether stopping the effective antibiotic treatment following clinical improvement at Day 7 (Truncated treatment) would be non-inferior to continued treatment until Day 14 (Continued treatment) in patients with acute pyelonephritis (APN) requiring hospitalization treated with non-fluoroquinolone (non-FQ) antibiotics.MethodsHospitalized adult men and non-pregnant women with culture-confirmed APN were eligible for participation after they had clinically improved following empirical or culture-guided treatment with intravenous non-FQ antibiotic(s). We excluded patients with severe sepsis, abscesses, prostatitis, recurrent or catheter-associated urinary tract infection, or urinary tract obstruction. We randomized eligible patients on Day 7 of effective treatment and assessed them at Weeks 1 and 6 after treatment completion. The primary outcome was retreatment for recurrent urinary tract infection. The prespecified non-inferiority margin was 15%.ResultsBetween March 17, 2015 and August 22, 2016, we randomly allocated 54 patients—27 patients in each arm. Twenty-four (44%) patients were male, and 26 (48%) had diabetes mellitus. Escherichia coli was the most common urinary isolate (47 [87%] patients); 36 (78%) were resistant to ciprofloxacin. In all, 41 (76%) patients received amikacin-based treatment. At the end of 6 weeks, no patient in the truncated treatment arm required retreatment, whereas 1 patient in the continued treatment arm was retreated. Difference (90% CI) in retreatment was −3.7% (−15.01% to 6.15%). Upper bound of the difference (6.15%) was below the prespecified limit, establishing non-inferiority of truncated treatment. Asymptomatic bacteriuria at Week 6 was similar between the two arms (3/24 vs. 3/26; P = 1.0). Patients in the truncated treatment arm had significantly shorter hospital stay (8 [7–10] vs. 14 [14–15] days; P < 0.001) and less antibiotic consumption per patient (8.4 ± 2.8 vs. 17.4 ± 8.3 DDDs; P < 0.001).ConclusionStopping the effective non-FQ antibiotics following clinical improvement at Day 7 is non-inferior to continued treatment until Day 14 in selected patients with APN requiring hospitalization.Trial registrationClinical Trials Registry-India; CTRI/2016/04/006810.

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“…However, apart from human resources, in terms of pharmacists and technicians [ 128 ], the implementation of an OPAT program as described here requires optimal infrastructure, including certified clean rooms and the availability of infusion devices. Unfortunately, these requirements are not available worldwide, leading to a low implementation of OPAT programs throughout the least developed countries, such as Asian countries, where only 3% of hospitals present a comprehensive program with specialist oversight [ 130 ]. Therefore, benchmarking indicators are a useful tool to determine consensus high-quality standards and, beyond peer comparison, can be used by each organization to define its own strategies in order to achieve these quality standards.…”

Section: Managing Pharmacy Department In An Opat Multidisciplinary Ci...mentioning

confidence: 99%

Successful Integration of Clinical Pharmacists in an OPAT Program: A Real-Life Multidisciplinary Circuit

et al. 2022

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Outpatient parenteral antimicrobial therapy (OPAT) programs encompass a range of healthcare processes aiming to treat infections at home, with the preferential use of the intravenous route. Although several barriers arise during the implementation of OPAT circuits, recent cumulative data have supported the effectiveness of these programs, demonstrating their application in a safe and cost-effective manner. Given that OPAT is evolving towards treating patients with higher complexity, a multidisciplinary team including physicians, pharmacists, and nursing staff should lead the program. The professionals involved require previous experience in infectious diseases treatment as well as in outpatient healthcare and self-administration. As we describe here, clinical pharmacists exert a key role in OPAT multidisciplinary teams. Their intervention is essential to optimize antimicrobial prescriptions through their participation in stewardship programs as well as to closely follow patients from a pharmacotherapeutic perspective. Moreover, pharmacists provide specialized counseling on antimicrobial treatment technical compounding. In fact, OPAT elaboration in sterile environments and pharmacy department clean rooms increases OPAT stability and safety, enhancing the quality of the program. In summary, building multidisciplinary teams with the involvement of clinical pharmacists improves the management of home-treated infections, promoting a safe self-administration and increasing OPAT patients’ quality of life.

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Outpatient parenteral antibiotic therapy (OPAT) in Asia: missing an opportunity

Cited by 9 publications

References 22 publications

Safety and efficacy of a 5-minute infusion versus the standard 30-minute infusion for antibiotics in an outpatient setting

Safety and efficacy of a 5-minute infusion versus the standard 30-minute infusion for antibiotics in an outpatient setting

Stopping the effective non-fluoroquinolone antibiotics at day 7 vs continuing until day 14 in adults with acute pyelonephritis requiring hospitalization: A randomized non-inferiority trial

Successful Integration of Clinical Pharmacists in an OPAT Program: A Real-Life Multidisciplinary Circuit

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