Outpatient parenteral antimicrobial therapy and antibiotic stewardship: opponents or teammates?

Steffens, Ester; Quintens, Charlotte; Derdelinckx, Inge; Peetermans, Willy; Eldere, Johan Van; Spriet, Isabel; Schuermans, Annette

doi:10.1007/s15010-018-1250-1

Cited by 30 publications

(23 citation statements)

References 76 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In our current work, we studied the stability of ampicillin solutions in analogous conditions to those candidates for the treatment of E. faecalis infective endocarditis in OPAT (9,28). Moreover, ampicillin utility in OPAT is applicable to other infections, such as bacteremia caused by susceptible Escherichia coli or enterococcal species or Listeria monocytogenes meningitis, providing a secure and low-ecological-impact alternative.…”

Section: Discussionmentioning

confidence: 99%

Ampicillin and Ceftriaxone Solution Stability at Different Temperatures in Outpatient Parenteral Antimicrobial Therapy

Herrera‐Hidalgo

López-Cortes

Luque‐Márquez

et al. 2020

Antimicrob Agents Chemother

View full text Add to dashboard Cite

The inclusion of ampicillin-containing regimens in outpatient parenteral antimicrobial therapy programs (OPAT) depends upon solution stability under conditions similar to those experienced in these programs. Lack of this information could hinder the inclusion in OPAT of patients suffering from Enterococcus faecalis infective endocarditis treated with ampicillin plus ceftriaxone. The purpose of this study is to determine the stability of ampicillin and ampicillin plus ceftriaxone solutions in a simulated outpatient setting conditions. Solutions of ampicillin 24 g/liter and ampicillin 24 g/liter combined with ceftriaxone 8 g/liter were stored at 25°C ± 2°C, 30°C ± 2°C and 37°C ± 2°C for 48 h. Chemical and physical stability were evaluated at 20, 24, 30, and 48 h after manufacturing. The solutions were considered stable if the percentage of intact drug was ≥90% and color and clearness remained unchanged. After 24 h of storage at a controlled temperature, ampicillin solution in 0.9% sodium chloride was found to be stable for 30 h at 25 and 30°C and for 24 h at 37°C. In the ampicillin plus ceftriaxone combined solution, both antibiotics were found to be stable after 30 h of storage at 25 and 30°C, but at 37°C, the stability criterion was not met at any time point. Our study offers solid evidence demonstrating that the concentrations of both drugs at two of the tested temperatures (25°C and 30°C) were stable for up to 30 h. Therefore, both ampicillin alone and ampicillin plus ceftriaxone solutions would be appropriate candidates for inclusion in OPAT programs.

show abstract

Section: Discussionmentioning

confidence: 99%

Ampicillin and Ceftriaxone Solution Stability at Different Temperatures in Outpatient Parenteral Antimicrobial Therapy

Herrera‐Hidalgo

López-Cortes

Luque‐Márquez

et al. 2020

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…Finally, there could be a danger of reinforcing multi- but not inter-disciplinarity, by fostering parallel professional lines where a nurse, for example, would address and engage with nursing practices, whilst other professionals supervise and support their own cadres, in tune with existing evidence about social and team demarcations in antimicrobial prescribing [34]. To mitigate such fragmentation, a priori efforts would be vital to identify boundaries and relations between the spheres of responsibility and influence of the new role and others, for example between infection prevention and control, or specialist sepsis nurses [35].…”

Section: Resultsmentioning

confidence: 99%

Nurse roles in antimicrobial stewardship: lessons from public sectors models of acute care service delivery in the United Kingdom

Castro-Sánchez

Gilchrist

Ahmad

et al. 2019

Antimicrob Resist Infect Control

View full text Add to dashboard Cite

BackgroundHealth care services must engage all relevant healthcare workers, including nurses, in optimal antimicrobial use to address the global threat of drug-resistant infections. Reflecting upon the variety of antimicrobial stewardship (AMS) nursing models already implemented in the UK could facilitate policymaking and decisions in other settings about context-sensitive, pragmatic nurse roles.MethodsWe describe purposefully selected cases drawn from the UK network of public sector nurses in AMS exploring their characteristics, influence, relations with clinical and financial structures, and role content.ResultsAMS nursing has been deployed in the UK within ‘vertical’, ‘horizontal’ or ‘hybrid’ models. The ‘vertical’ model refers to a novel, often unique consultant-type role ideally suited to transform organisational practice by legitimising nurse participation in antimicrobial decisions. Such organisational improvements may not be straightforward, though, due to scalability issues. The ‘horizontal’ model can foster coordinated efforts to increase optimal AMS behaviours in all nurses around a narrative of patient safety and quality. Such model may be unable to address tensions between the required institutional response to sepsis and the inappropriate use of antibiotics. Finally, the ‘hybrid’ model would increase AMS responsibilities for all nurses whilst allocating some expanded AMS skills to existing teams of specialists such as sepsis or vascular access nurses. This model can generate economies of scale, yet it may be threatened by a lack of clarity about a nurse-relevant vision.ConclusionsA variety of models articulating the participation of nurses in antimicrobial stewardship efforts have already been implemented in public sector organisations in the UK. The strengths and weaknesses of each model need considering before implementation in other settings and healthcare systems, including precise metrics of success and careful consideration of context-sensitive, resource dependent and pragmatic solutions.

show abstract

“…Last but not least, drug degradation may lead to toxic byproducts [17]. Regarding amoxicillin we have identified four degradation products, Among them, amoxicilloic acid and diketopiperazine amoxicillin have been identified as the two major degradation products of amoxicillin.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, OPAT improves quality of life, and portable elastomeric pumps gives patients more flexibility and control over their treatment [15]. Among the important aspects described in OPAT practice guidelines, drug stability has been underlined as a crucial point to be taken into consideration to ensure efficacy and safety of antimicrobial therapy [12,16,17]. In a recent survey, osteomyelitis, prosthetic joint infections and endocarditis were the most commonly reported indications for OPAT [18].…”

Section: Introductionmentioning

confidence: 99%

Overcoming stability challenges during continuous intravenous administration of high-dose amoxicillin using portable elastomeric pumps

et al. 2019

View full text Add to dashboard Cite

While treatment of serious infectious diseases may require high-dose amoxicillin, continuous infusion may be limited by lack of knowledge regarding the chemical stability of the drug. Therefore, we have performed a comprehensive study so as to determine the chemical stability of high-dose amoxicillin solutions conducive to safe and effective continuous intravenous administration using portable elastomeric pumps. First, amoxicillin solubility in water was assessed within the range of 25 to 300 mg/mL. Then, amoxicillin solutions were prepared at different concentrations (25, 50, 125, 250 mg/mL) and stored in different conditions (5±2°C, 25±1°C, 30±1°C and 37±1°C) to investigate the influence of concentration and temperature on the chemical stability of amoxicillin. Finally, its stability was assessed under optimized conditions using a fully validated HPLC-UV stability-indicating method. Degradation products of amoxicillin were investigated by accurate mass determination using high-resolution mass spectrometry. Amoxicillin displayed limited water solubility requiring reconstitution at concentrations below or equal to 150 mg/mL. Amoxicillin degradation were time, temperature as well as concentration-dependent, resulting in short-term stability, in particular at high concentrations. Four degradation products of amoxicillin have been identified. Among them, amoxicilloic acid and diketopiperazine amoxicillin are at risk of allergic reaction and may accumulate in the patient. Optimized conditions allowing for continuous infusion of high-dose amoxicillin has been determined: amoxicillin should be reconstituted at 25 mg/mL and stored up to 12 hours at room temperature (22 ± 4°C) or up to 24 hours between 4 and 8°C.

show abstract

Outpatient parenteral antimicrobial therapy and antibiotic stewardship: opponents or teammates?

Cited by 30 publications

References 76 publications

Ampicillin and Ceftriaxone Solution Stability at Different Temperatures in Outpatient Parenteral Antimicrobial Therapy

Ampicillin and Ceftriaxone Solution Stability at Different Temperatures in Outpatient Parenteral Antimicrobial Therapy

Nurse roles in antimicrobial stewardship: lessons from public sectors models of acute care service delivery in the United Kingdom

Overcoming stability challenges during continuous intravenous administration of high-dose amoxicillin using portable elastomeric pumps

Contact Info

Product

Resources

About