November 13, 2018
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New OPAT guidelines emphasize role of ID specialist

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Updated clinical practice guidelines from the Infectious Diseases Society of America emphasize the role of infectious disease specialists in ensuring that patients receiving outpatient parenteral antimicrobial therapy, or OPAT, are treated appropriately.

According to the updated guidance, all OPAT orders should be reviewed by an ID physician, nurse or pharmacist before patients begin therapy and are adjusted as needed. Once on therapy, patients should be monitored regularly.

Since the previous guidelines were published in 2004, research has shown that OPAT is safe and preferred by patients, and that consulting with an ID specialist about the therapy reduces hospital admissions and health care spending.

The IDSA noted that an ID specialist often recommends that a patient receive oral instead of IV antibiotics, and that some patients may not need antibiotics at all.

“The majority of patients referred for OPAT therapy do need it, but in many cases an oral antimicrobial would do the job,” Anne H. Norris, MD, guidelines co-chair and associate professor of clinical medicine at the University of Pennsylvania Perelman School of Medicine, said in a news release.

“Given the growing worldwide problem with antimicrobial overuse and resistance, any opportunity to de-escalate these drugs is critically important,” Norris said. “Not only does this provide good stewardship of antimicrobials, [it] lowers costs and potentially improves patients’ well-being. It’s always better to avoid IV access if possible, and the narrower spectrum oral antimicrobials kill off fewer healthy bacteria than broader spectrum agents.”

The updated guidelines do not offer recommendations on the treatment of specific infections and are not meant to replace clinical judgment in the management of individual patients, the authors noted.

Other new recommendations include guidance on OPAT vancomycin, patients without allergies, use of midline catheters and blood clots in patients with peripherally inserted central catheters.

Reference:

Norris AH, et al. Clin Infect Dis. 2018;doi:10.1093/cid/ciy745.