Management of outpatient parenteral antimicrobial therapy : Updated IDSA guideline

Infectious Diseases Society of America (IDSA) has released its Updated guideline on Management of outpatient parenteral antimicrobial therapy. These include detailed recommendations and information in the context of greatly expanded OPAT use in recent years. and shall benefit Infectious disease clinicians and others caring for patients receiving outpatient parenteral antimicrobial therapy (OPAT).

The new guidelines build on the previous version of 2004 and have expanded sections on treatment logistics, antimicrobial selection and monitoring, vascular access devices and complications, and common toxicities.

Key Points of the guideline are-

• OPAT administered at home by patients or their caregivers is a safe and effective option for completion of antimicrobial therapy.


• Before OPAT initiation, an infectious diseases (ID) expert should review all cases. This review limits the unnecessary use of parenteral therapy and improves care coordination.


• Elderly patients should not be excluded from home OPAT, provided that they or their caregivers have sufficient cognition, mobility, and dexterity to manage the infusions.


• Laboratory monitoring is recommended and reduces readmission rates, although data are insufficient to make evidence-based recommendations about the type and frequency of monitoring for specific drugs. Vancomycin blood levels should be monitored regularly.

New Inclusion in the updated Guideline:

• The new guidelines support administrating the first dose of a new antimicrobial in the home setting in patients without prior histories of allergy to drugs in the same class, provided the dose is supervised by healthcare personnel qualified to treat anaphylactic reactions.


• More information on the selection of vascular access devices (VAD) is included. Midline catheters are acceptable for OPAT courses <14 days in adult patients. Use of central venous catheters for vancomycin infusion is not mandatory. Patients with chronic kidney disease should preferentially receive tunnelled over peripherally inserted central catheters.


• The updated guidelines have tables on many antimicrobials, including details about administration methods, infusion time, oral bioavailability, laboratory monitoring recommendations, and adverse drug reactions. Non–laboratory-based toxicities that inform monitoring strategies (e.g., hypersensitivity, torsades risk) are also included.

These guidelines give a call for a national OPAT registry and will go a long way in helping clinicians caring for patients on OPAT .