Outpatient Subcutaneous Antimicrobial Therapy (OSCAT) as a Measure to Improve the Quality and Efficiency of Healthcare Delivery for Patients With Serious Bacterial Infections

Abstract

Since the 1970s, outpatient parenteral antimicrobial therapy (OPAT) has been a viable option for patients who require intravenous antibiotics when hospitalization is not warranted. While the benefits of OPAT as a measure to improve the efficiency of healthcare delivery (i.e., reduced hospital days) and patient satisfaction are well-documented, OPAT is associated with a number of challenges, including line complications and reliance on daily healthcare interactions in some cases at home or in a clinic. To minimize the continued need for intensive healthcare services in the outpatient setting, there is trend toward patients self-administering antibiotics at home without the presence of healthcare workers, after adequate training. In most cases, patients administer the antibiotics through an established intravenous catheter. While this OPAT practice is becoming more accepted as a standard of care, the potential for line complications still exists. Outpatient subcutaneous antimicrobial therapy (OSCAT) has become an increasingly accepted alternative route of administration of antibiotics to IV by French infectious diseases physicians and geriatricians; however, currently, no antibiotics are approved to be administered subcutaneously. Antibiotics with longer half-lives that are completely absorbed and have a favorable local tolerability profile are ideal candidates for OSCAT and have the potential to maximize the quality and efficiency of parenteral antibiotic delivery in the outpatient setting. The increasing development of wearable, on-body subcutaneous delivery systems make OSCAT even more viable as they increase patient independence while avoiding line complications and potentially removing the need for direct healthcare professional observation.

Safety of subcutaneous versus intravenous ceftriaxone administration in older patients: A retrospective study

“…A study on immunoglobulins administered at home reported better quality of life when using the SC route 40 . Ferry et al presented several SC delivery systems that can be used in older patients when the IV route is not accessible 41 . Their development is still in progress, and more studies are needed on the safety of subcutaneously administered ceftriaxone in outpatient settings, with and without these devices.…”

Telling the difference and the telling differences between hospital in the home and outpatient parenteral antibiotic therapy

“…S-OPAT models involve either selected patients or carers administering their intravenous medications at home. 7,8 This also involves weekly visits to the hospital to collect supplies and antibiotics, or a home infusion nurse visiting patients at home around weekly to refill supplies. Self-administration was developed as a way to enable antibiotic administration while minimising staffing visits.…”

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

“…It must be noted that, mainly in geriatric patients, it can be difficult to find an optimal venous access for catheter insertion. For these situations, outpatient subcutaneous antimicrobial therapy (OSCAT) has become a widely accepted alternative [ 125 ] that is also accepted in our HaH unit. However, this route of administration is not yet approved for any antimicrobial in the summary of product characteristics, although some publications support OSCAT, mainly for antimicrobials with longer half-lives, such as ceftriaxone and ertapenem [ 125 ].…”