Practice Guidelines for Outpatient Parenteral Antimicrobial Therapy

Tice, Alan D.; Rehm, Susan J.; Dalovisio, Joseph R.; Bradley, John S.; Martinelli, Lawrence P.; Graham, Donald R.; Gainer, R. Brooks; Künkel, M; Yancey, Robert W.; Williams, David N.

doi:10.1086/420939

Cited by 492 publications

(379 citation statements)

References 176 publications

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“…Outpatient parenteral antibiotic therapy (OPAT) is efficacious, safe, and cost-effective for a variety of infections, [323][324][325] including IE that requires prolonged parenteral therapy in hospitalized patients who otherwise no longer require inpatient care but do require continued parenteral antimicrobial therapy. Antibiotic regimens recommended for IE vary widely and often require ≥4 weeks of therapy, generally given by the intravenous route.…”

Section: Outpatient Therapymentioning

confidence: 99%

Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications

Baddour¹,

Wilson²,

Bayer³

et al. 2015

Circulation

2,540

1,421

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Background— Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today’s myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances. Methods and Results— This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidence-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations. Conclusions— Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.

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Section: Outpatient Therapymentioning

confidence: 99%

Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications

Baddour¹,

Wilson²,

Bayer³

et al. 2015

Circulation

2,540

1,421

View full text Add to dashboard Cite

show abstract

“…The IDSA practice guideline for OPAT recommends monitoring once-weekly complete blood count (CBC) and basic metabolic panel to monitor for adverse events in patients receiving cephalosporin therapy. The guideline also suggests more frequent monitoring of laboratory data if an adverse trend is identified during laboratory monitoring; however, the guideline does not give recommendations on how frequently (27).…”

Section: Discussionmentioning

confidence: 99%

Neutropenia Associated with Long-Term Ceftaroline Use

LaVie

Anderson

O’Neal

et al. 2016

Antimicrob Agents Chemother

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dCeftaroline is a fifth-generation cephalosporin with potent antimicrobial activity against Gram-positive and Gram-negative pathogens. Neutropenia is a rare serious adverse event for the class of cephalosporins; however, we observed several cases of severe neutropenia in our outpatient infectious disease practice believed to be associated with ceftaroline use. The aim of this study was to determine the incidence of neutropenia among patients receiving ceftaroline therapy for more than 7 days. We conducted a retrospective cohort analysis of patients admitted to an 800-bed regional medical center between June 2012 and December 2014 who received ceftaroline for more than 7 days to assess the incidence of developing clinically significant neutropenia. Demographic and patient care data points as well as underlying admitting and chronic diagnoses were retrospectively collected from the medical record. Clinically significant neutropenia was defined as an absolute neutrophil count (ANC) less than 1,500 cells/ mm 3 . Analysis was performed to determine the incidence, severity, and outcome of neutropenia following ceftaroline administration. A total of 39 patients were included in the cohort. The median duration of therapy was 27 days. Seven patients (18%) developed neutropenia while on ceftaroline therapy. Four (10%) of the neutropenic patients had an ANC of <500 cells/mm 3 . The median first neutropenic day was day 17, with the median ANC nadir of 432 cells/mm 3 on day 24. We determined that extended ceftaroline infusion is associated with the development of neutropenia. We recommend obtaining a complete blood count (CBC) with differential at the onset of therapy and weekly thereafter. Should the ANC fall below 2,500 cells/mm 3 , then twice-weekly CBCs should be monitored for the duration of ceftaroline therapy, and therapy should be discontinued if the ANC falls to 1,500 cells/mm 3 or less.

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“…Furthermore, fewer patients completed prespecified treatment courses with nafcillin than did those treated with cefazolin (overall discontinuation rate, 34% versus 7%; P Ͻ 0.0001). ASPs are also more commonly associated with other untoward reactions, such as phlebitis and neutropenia (18,19). Other pharmacologic advantages of cefazolin over ASPs include lower sodium content and dosing convenience in patients on hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Cefazolin versus Oxacillin for Treatment of Complicated Bacteremia Caused by Methicillin-Susceptible Staphylococcus aureus

Echevarria

Hughes

et al. 2014

Antimicrob Agents Chemother

100

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e Contrary to prior case reports that described occasional clinical failures with cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infections, recent studies have demonstrated no difference in outcomes between cefazolin and antistaphylococcal penicillins for the treatment of MSSA bacteremia. While promising, these studies described low frequencies of high-inoculum infections, such as endocarditis. This retrospective study compares clinical outcomes of cefazolin versus oxacillin for complicated MSSA bacteremia at two tertiary care hospitals between January 2008 and June 2012. Fifty-nine patients treated with cefazolin and 34 patients treated with oxacillin were included. Osteoarticular (41%) and endovascular (20%) sources were the predominant sites of infection. The rates of clinical cure at the end of therapy were similar between cefazolin and oxacillin (95% versus 88%; P ‫؍‬ 0.25), but overall failure at 90 days was higher in the oxacillin arm (47% versus 24%; P ‫؍‬ 0.04). Failures were more likely to have received surgical interventions (63% versus 40%; P ‫؍‬ 0.05) and to have an osteoarticular source (57% versus 33%; P ‫؍‬ 0.04). Failures also had a longer duration of bacteremia (7 versus 3 days; P ‫؍‬ 0.0002), which was the only predictor of failure. Antibiotic selection was not predictive of failure. Rates of adverse drug events were higher in the oxacillin arm (30% versus 3%; P ‫؍‬ 0.0006), and oxacillin was more frequently discontinued due to adverse drug events (21% versus 3%; P ‫؍‬ 0.01). Cefazolin appears similar to oxacillin for the treatment of complicated MSSA bacteremia but with significantly improved safety. The higher rates of failure with oxacillin may have been confounded by other patient factors and warrant further investigation.

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Practice Guidelines for Outpatient Parenteral Antimicrobial Therapy

Cited by 492 publications

References 176 publications

Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications

Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications

Neutropenia Associated with Long-Term Ceftaroline Use

Comparison of Cefazolin versus Oxacillin for Treatment of Complicated Bacteremia Caused by Methicillin-Susceptible Staphylococcus aureus

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