Home intravenous antibiotherapy and the proper use of elastomeric pumps: Systematic review of the literature and proposals for improved use

Diamantis, S.; Dawudi, Yachar; Cassard, Bruno; Longuet, P; Lesprit, Philippe; Gauzit, R.

doi:10.1016/j.medmal.2020.10.019

Cited by 24 publications

(21 citation statements)

References 62 publications

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“…The first one [ 55 ] updates the data from a previous study [ 56 ] that was carried out to find out if the stability of antimicrobials in elastomeric pumps meets the quality standards of the Yellow Covered Document (YCD) from the UK National Health System. The second one [ 57 ] focuses on evaluating the different means of using elastomeric infusion pumps in out-of-hospital administration of intravenous antibiotics. Therefore, there is no systematic review that provides information on the physicochemical stability of antimicrobials in elastomers together.…”

Section: Discussionmentioning

confidence: 99%

Stability of Antimicrobials in Elastomeric Pumps: A Systematic Review

et al. 2021

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Outpatient parenteral antimicrobial therapy (OPAThttp) programs have become an important healthcare tool around the world. Portable elastomeric infusion pumps are functional devices for ambulatory delivery of antimicrobial drugs, and their stability is an essential point to guarantee an appropriate infusion administration. We conducted a systematic review to provide a synthesis and a critical evaluation of the current evidence regarding antimicrobial stability in elastomeric pumps. Data sources were PubMed, EMBASE, and Web of Sciences. The review protocol was registered on the Center for Open Science, and it was carried out following the PRISMA guidelines. Studies were eligible if the aim was the evaluation of the physicochemical stability of an antimicrobial agent stored in an elastomeric device. Of the 613 papers identified, 33 met the inclusion criteria. The most studied group of antimicrobials was penicillins, followed by cephalosporins and carbapenems. In general, the stability results of the antimicrobials that have been studied in more than one article agree with each other, with the exception of ampicillin, flucloxacillin, and ceftazidime. The antibiotics that displayed a longer stability were glycopeptides and clindamycin. Regarding the stability of antifungals and antivirals, only caspofungin, voriconazole, and ganciclovir have been investigated. The information provided in this article should be considered in patient treatments within the OPAT setting. Further stability studies are needed to confirm the appropriate use of the antimicrobials included in this program to ensure optimal patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Stability of Antimicrobials in Elastomeric Pumps: A Systematic Review

et al. 2021

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“…Additionally, differing from traditional prescriptions, OPAT regimens need to consider the final administration volume and the maximum concentration permitted as well as the flow rate and infusion time. The stability of the final product depends on these data and, in consequence, the choice of the optimal administration device for each patient and infection depends on the previously mentioned parameters [ 64 ]. Since several factors need to be considered, a joint evaluation and discussion by the whole multidisciplinary team is required.…”

Section: Implementation Of An Opat Multidisciplinary Circuitmentioning

confidence: 99%

“…Unfortunately, extended and continuous administration in an OPAT setting involves technical difficulties. For self-administration extended regimens (from 3 to 5 h), the availability of elastomeric devices is limited [ 64 ], as occurs in our HaH unit. In the case of continuous administration (24 h), for which adequate devices are available in our unit, the main handicap is the stability of the antimicrobial preparation, mainly in the spring–summer period, when stability is reduced due to higher temperatures.…”

Section: Implementation Of An Opat Multidisciplinary Circuitmentioning

confidence: 99%

“…Beyond the validation process directly related with antibiotic selection and prescription, pharmacists in HaH units confer an essential value to multidisciplinary teams, given their knowledge in the technical aspects related to OPAT preparation [ 72 ]. At this point, several factors such as antimicrobial stability, solvent choice, the final antimicrobial concentration, compatibility between the drugs and materials used, the type of infusion device, and storage conditions should be considered [ 64 ].…”

Section: Implementation Of An Opat Multidisciplinary Circuitmentioning

confidence: 99%

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Successful Integration of Clinical Pharmacists in an OPAT Program: A Real-Life Multidisciplinary Circuit

et al. 2022

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Outpatient parenteral antimicrobial therapy (OPAT) programs encompass a range of healthcare processes aiming to treat infections at home, with the preferential use of the intravenous route. Although several barriers arise during the implementation of OPAT circuits, recent cumulative data have supported the effectiveness of these programs, demonstrating their application in a safe and cost-effective manner. Given that OPAT is evolving towards treating patients with higher complexity, a multidisciplinary team including physicians, pharmacists, and nursing staff should lead the program. The professionals involved require previous experience in infectious diseases treatment as well as in outpatient healthcare and self-administration. As we describe here, clinical pharmacists exert a key role in OPAT multidisciplinary teams. Their intervention is essential to optimize antimicrobial prescriptions through their participation in stewardship programs as well as to closely follow patients from a pharmacotherapeutic perspective. Moreover, pharmacists provide specialized counseling on antimicrobial treatment technical compounding. In fact, OPAT elaboration in sterile environments and pharmacy department clean rooms increases OPAT stability and safety, enhancing the quality of the program. In summary, building multidisciplinary teams with the involvement of clinical pharmacists improves the management of home-treated infections, promoting a safe self-administration and increasing OPAT patients’ quality of life.

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“…There is no international consensus on standards for stability assessment of antimicrobial agents in elastomeric devices, relevant for OPAT services, and most countries will follow the stipulations of their relevant national pharmacopoeias. A recent review of the use of elastomeric pumps for OPAT by Diamantis et al highlighted the importance of assessment of the stability of antibiotics in these devices 4. In the UK, the YCD requirements build on, and extend the requirements of the British Pharmacopoeia.…”

Section: Introductionmentioning

confidence: 99%

Widening the net: a literature review of antimicrobial agents with potential suitability for outpatient parenteral antimicrobial therapy services—the importance of storage and stability

et al. 2021

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ObjectivesOutpatient parenteral antimicrobial therapy (OPAT) services using continuous infusions (CIs) of antimicrobial agents in elastomeric devices require evidence of acceptable stability of the agent over the infusion period. A period of refrigerated storage of filled devices, followed by the CI period, is useful for OPAT services but can present a significant challenge to the stability of drugs. The aims of this study were to review fresh-filled stability data on antimicrobials which would be useful for OPAT services and to identify suitable candidates for further assessment.MethodsSearches identified papers relating to stability assessments of antimicrobials for immediate use tested above 31°C using a stability-indicating method.ResultsWe identified 18 stability studies published in 12 papers between 2015 and 2020, assessing the stability of 10 agents. Aminopenicillins like ampicillin and amoxicillin appear too unstable for CI, while benzylpenicillin may benefit from buffering to improve its stability. Cephalosporins vary in their stability and CI periods of 24 hours may not be achievable. Of the carbapenems, there are insufficient data for doripenem but meropenem has been extensively studied and is unsuitable for CI longer than 6 hours. Voriconazole may be suitable for CI but needs further investigation.ConclusionsSome drugs identified in our review are unlikely to be suitable for continuous infusion in OPAT services due to instability. Using a ‘fresh-fill’ approach, without refrigerated storage, may make some drugs useful while other agents should be considered for further assessment to Yellow Cover Document standards. The impact of buffering for penicillins should be assessed further.

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Home intravenous antibiotherapy and the proper use of elastomeric pumps: Systematic review of the literature and proposals for improved use

Cited by 24 publications

References 62 publications

Stability of Antimicrobials in Elastomeric Pumps: A Systematic Review

Stability of Antimicrobials in Elastomeric Pumps: A Systematic Review

Successful Integration of Clinical Pharmacists in an OPAT Program: A Real-Life Multidisciplinary Circuit

Widening the net: a literature review of antimicrobial agents with potential suitability for outpatient parenteral antimicrobial therapy services—the importance of storage and stability

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