Outpatient Parenteral Antimicrobial Therapy in Pediatrics: An Opportunity to Expand Antimicrobial Stewardship

Abstract

We reviewed patient discharges with outpatient parenteral antimicrobial therapy (OPAT) to determine whether outpatient parenteral antimicrobial therapy was modifiable or unnecessary at a large tertiary care children's hospital. At least one modification definitely or possibly would have been recommended for 78% of episodes. For more than 40% of episodes, outpatient parenteral antimicrobial therapy was potentially not indicated.

Comparative Effectiveness of Oral Versus Outpatient Parenteral Antibiotic Therapy for Empyema

“…There is a growing recognition that OPAT is overused and that overuse can be minimized through antimicrobial stewardship. 21,22 This is supported by an expanding evidence base indicating that the effectiveness of oral therapy is equivalent to OPAT for a variety of serious pediatric infections frequently treated with OPAT, including complicated appendicitis and osteomyelitis. [23][24][25][26] In a recent study comparing oral therapy with OPAT for osteomyelitis, rates of treatment failure were similar between groups.…”

Dedicated paediatric Outpatient Parenteral Antimicrobial Therapy medical support: a pre–post observational study

“…Clinicians often fail to provide adequate patient oversight7; Hodgson et al identified that 26% of their paediatric OPAT patients received an incorrect dose, route or duration of antibiotics and an inappropriate indication for treatment was cited in 6% 8. Overall, drug-related and line-related complications are reported to occur in 20% to 30% of paediatric OPAT patients, correlating with increasing intravenous therapy durations 4 9–12…”

Expanding Existing Antimicrobial Stewardship Programs in Pediatrics: What Comes Next

“…For example, ASPs can focus on children being discharged to undergo outpatient parenteral antimicrobial therapy (OPAT). Overuse of OPAT exposes patients to complications such as catheter-associated infections and thrombosis, and OPAT can be avoided in some children in favor of oral therapy for infections such as osteomyelitis [32,42,43]. Similarly, investigating and removing unnecessary β-lactam allergy labels represents an opportunity for ASPs to direct patients toward first-line, generally more narrow-spectrum, agents [44,45].…”