Safety and effectiveness of outpatient parenteral antimicrobial therapy in older people

Abstract

s-OPAT administered by patients or their caregivers using elastomeric devices was safe and effective in the treatment of infections in older people.

Safety and effectiveness of ‘hospital in the home’ and ‘outpatient parenteral antimicrobial therapy’ in different age groups: A systematic review of observational studies

“…The reasons for these rates of complications and adverse events might be self‐administration of antibiotics or the underlying medical conditions such as coronary artery disease, diabetes, peripheral vascular disease, congestive heart failure and malignancy in both groups. The study of Mujal et al had 3 age groups (above 80 years, between 65 and 80 and below 65), and the reported rates of VAD related adverse events were 15.8%, 17.6%, 20.2% respectively with 3% to 4% of patients requiring readmissions for VAD related events.…”

“…Special attention should be paid to patient selection and proper training should be given to patients and carers regarding drug dosage and storage, potential side effects, the use of devices such as infusion devices, ventilators and oxygen delivery devices and what to do in an emergency . Several eligibility criteria are considered in identifying suitable patients for HITH or OPAT, which include; clinical stability and patient consent, not living alone and having family support, living in the local referral area and the suitability of the home environment …”

“…Numerous studies assessing the adverse events (AEs) and effectiveness of HITH and OPAT have been performed in many countries including Australia, USA, UK, Spain, France, Singapore, Israel, Canada, Italy, Ireland, New Zealand, Saudi Arabia, Switzerland and Greece . Some studies have analysed the safety of HITH or OPAT for a particular disease or for a particular group including geriatric or paediatric patients …”

“…The studies used a number of indicators to study the safety and effectiveness of HITH or OPAT: cure or success rate; treatment failure rate; mortality rate; rate of complications with vascular access devices (VAD) including thrombosis, occlusion, removal, infection, phlebitis and bleeding; adverse drug reactions; unplanned telephone calls; unscheduled staff callouts; hospital readmission; treatment extension; and adverse events as defined by the Harvard Medical Practice Study—“the adverse event is an unplanned injury or complication caused by healthcare management which leads to disability, death or prolonged hospital stay.”…”

“…Older people who commonly have comorbid conditions are at a higher risk when admitted to HITH or OPAT . Children present different challenges to adults when cared for in the home and separate guidelines have been formed for paediatric OPAT services .…”