Safety of Outpatient Parenteral Antimicrobial Therapy in Children

Fernandes, Priyanka; Milliren, Carly E.; Mahoney-West, Helen; Schwartz, Laura; Lachenauer, Catherine S.; Nakamura, Mari

doi:10.1097/inf.0000000000001716

Cited by 16 publications

(9 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…30,[32][33][34][35][36][37][38][39][40] Indeed, neutropenia was one of the most common adverse drug-related effects of outpatient parenteral antimicrobial therapy (OPAT) in pediatric patients regardless of the antibiotic agent used. [41][42][43][44] Confirming this finding, Fernandes et al 45 found that leukopenia developed in 6% of pediatric patients on OPAT for a median of 30 days. Of note, the antibiotic trimethoprim-sulfamethoxazole (TMP-SMZ) is widely known to cause neutropenia, but the rate of TMP-SMZ-mediated neutropenia is far lower than that reported for other antibiotics, such as b-lactams.…”

Section: Suppression Of Hematopoiesis Associated With Dysbiosis In Humentioning

confidence: 72%

Hematopoiesis and the bacterial microbiome

Yan

Baldridge²,

King

2018

Blood

View full text Add to dashboard Cite

Recent studies have revealed that the intestinal bacterial microbiome plays an important role in the regulation of hematopoiesis. A correlation between adverse hematologic effects and imbalance of the intestinal microbiome, or dysbiosis, is evident in several human conditions, such as inflammatory bowel disease, obesity, and, critically, in the setting of antibiotic exposure. Here we review the effects of gut dysbiosis on the hematological compartment and our current understanding of the mechanisms through which changes in the bacterial microbiome affect hematopoiesis.

show abstract

Section: Suppression Of Hematopoiesis Associated With Dysbiosis In Humentioning

confidence: 72%

Hematopoiesis and the bacterial microbiome

Yan

Baldridge²,

King

2018

Blood

View full text Add to dashboard Cite

show abstract

“…Antibiotic therapy is necessary to treat life-threatening bacterial infections, with approximately 249.8 million antibiotic prescriptions being issued in the United States annually [1]. However, prolonged use of antibiotics (two weeks or longer) is associated with adverse events, including bone marrow suppression [2][3][4][5]. With incidence ranging between 5-34%, bone marrow suppression is one of the most common antibiotic-associated adverse events, and can present as anemia and/or neutropenia [6].…”

Section: Introductionmentioning

confidence: 99%

“…With incidence ranging between 5-34%, bone marrow suppression is one of the most common antibiotic-associated adverse events, and can present as anemia and/or neutropenia [6]. Antibiotic-associated bone marrow suppression leads to unplanned outpatient visits, hospitalizations and early discontinuation of antibiotic therapy [3]. Unfortunately, survival for some, particularly immunocompromised oncology and bone marrow transplant patients, may depend on continuing antibiotic therapy, precluding early discontinuation.…”

Section: Introductionmentioning

confidence: 99%

Broad-Spectrum Antibiotics Deplete Bone Marrow Regulatory T Cells

Han

Yan

King

2021

Cells

View full text Add to dashboard Cite

Bone marrow suppression, including neutropenia, is a major adverse effect of prolonged antibiotic use that impairs the clinical care and outcomes of patients with serious infections. The mechanisms underlying antibiotic-mediated bone marrow suppression remain poorly understood, with initial evidence indicating that depletion of the intestinal microbiota is an important factor. Based on our earlier studies of blood and bone marrow changes in a mouse model of prolonged antibiotic administration, we studied whether changes in megakaryocytes or regulatory T cells (Tregs), two cell types that are critical in the maintenance of hematopoietic stem cells, contribute to antibiotic-mediated bone marrow suppression. Despite increased platelet numbers, megakaryocytes were unchanged in the bone marrow of antibiotic-treated mice; however, Tregs were found to be significantly depleted. Exogenous addition of Tregs was insufficient to rescue the function of bone marrow from antibiotic-treated mice in both colony formation and transplantation assays. These findings indicate that the intestinal microbiota support normal Treg development to protect healthy hematopoiesis, but that the restoration of Tregs alone is insufficient to restore normal bone marrow function.

show abstract

“…In developing the first P-OPAT in Indonesia, several challenges were faced including the adaptation of the national insurance reimbursement financial model to support the P-OPAT; obtaining approval from multiple levels of hospital, regional, and national authorities; and promoting awareness and confidence in P-OPAT services among hospital physicians, patients, and patient's family. The extent of P-OPAT services in Indonesia was limited because of the lack of elastomeric infusors to deliver antibiotics that would otherwise require multiple daily dosing which is a standard practice in other OPAT centers (5,9,12). In Indonesia, the elastomeric infusor is still undergoing the national registration process; thus, this limits eligible patients to those requiring once daily single-dose antibiotics.…”

Section: Discussionmentioning

confidence: 99%

“…Although the first OPAT was started in pediatric patients (8). the treatment progress in the pediatric population has not been as fast as in adults (9) OPAT has been proven to be effective, efficient (10), and safe, with low complication rates in both adult and pediatric populations (11,12). On the other hand, in LMICs, OPAT is not yet well-established.…”

Section: Introductionmentioning

confidence: 99%

First Pediatric Outpatient Parenteral Antibiotic Therapy Clinic in Indonesia

et al. 2020

View full text Add to dashboard Cite

Background: Infection remains a major pediatric health problem in Indonesia and usually leads to longer hospitalization due to the need for extended intravenous antibiotic administration. In developed countries, pediatric outpatient parenteral antibiotic therapy (P-OPAT) is well-established and proven to be safe and effective at reducing the length of hospital stay; however, data on low-and middle-income countries such as Indonesia remain limited. This P-OPAT service is new and the first service in Indonesia. Methods:The medical records of patients attending Indonesia's first P-OPAT clinic between April 2015 and March 2017 were retrospectively investigated.Results: During the 24-month period, 32 patients received treatment at the P-OPAT clinic, saving a total of 258 bed days. The majority of patients (n = 16; 50%) were diagnosed with urinary tract infection, followed by cellulitis (n = 4; 12.5%) and osteomyelitis (n = 4; 12.5%). Ceftriaxone was the most commonly used antibiotic (n = 16; 50%). All patients used a peripheral intravenous catheter and were sent home with this device. Twelve patients (37.5%) needed to change IV access more than once. None of the patients used elastomeric infusor device. The median duration of OPAT was 5 days (range 1-27 days). All patients were successfully treated with no recurrence after 30 days. One patient (3.1%) experienced drug-related complication and another one (3.1%) was readmitted due to an underlying medical condition. All the patients complied with P-OPAT schedules.Conclusions: P-OPAT service offers a safe and effective option for the delivery of outpatient intravenous antibiotics in selected patients even in resource-poor settings.

show abstract

Safety of Outpatient Parenteral Antimicrobial Therapy in Children

Abstract: Use of oxacillin during OPAT was associated with higher rate of AD. Patients treated with clindamycin and those with a peripherally inserted central catheter had higher rates of unplanned outpatient visits. Providers should strongly consider alternative treatment options when possible.

Cited by 16 publications

References 16 publications

Hematopoiesis and the bacterial microbiome

Hematopoiesis and the bacterial microbiome

Broad-Spectrum Antibiotics Deplete Bone Marrow Regulatory T Cells

First Pediatric Outpatient Parenteral Antibiotic Therapy Clinic in Indonesia

Contact Info

Product

Resources

About