Symposium on antimicrobial therapyPractical Considerations in the Use of Outpatient Antimicrobial Therapy for Musculoskeletal Infections
Section snippets
Patient Evaluation and Selection
Patients who are candidates for outpatient parenteral antimicrobial therapy (OPAT) can have a variety of musculoskeletal infectious syndromes such as osteomyelitis, prosthetic joint infections, diabetes-related foot infections, and soft tissue or surgical site infections. Available data from the medical literature and expert opinion support the effectiveness of prolonged, directed, systemic antimicrobial therapy (4-6 weeks or longer) for adults with many musculoskeletal infections.1, 2, 3, 4, 5
Oral Antimicrobial Therapy
In general, there is little difference between the oral and parenteral route as long as both routes provide adequate serum and bone concentrations. Traditionally, the parenteral route has been the preferred modality of administration for many musculoskeletal infections, particularly for treatment of osteomyelitis in adults and for prosthetic joint infections. However, if fully bioavailable (ie, quinolones, metronidazole, linezolid), antimicrobials can be administered orally.23, 24, 25, 26
Clinical and Laboratory Monitoring of Treatment Efficacy and Toxicity
Complications related to antimicrobials in an outpatient setting are similar to those in the inpatient setting. Common complications of antimicrobial therapy include rash, nausea, vomiting, diarrhea, Clostridium difficile–associated colitis, and oropharyngeal or vaginal candidiasis; more unusual complications include ototoxicity from vancomycin or aminoglycosides.8 Patients should be educated and counseled about possible antimicrobial adverse effects and toxicities and should be instructed to
Conclusion
The administration of outpatient parenteral antimicrobial therapy has been proved to be an efficacious, safe, practical, and cost-effective method. It allows patients to return to their daily activities with minimal discomfort or disruptions of their schedules. Outpatient intravenous antimicrobial therapy is a vital component of the medical treatment of many musculoskeletal infections. Oral therapy can be administered in selected circumstances. We have provided an overview of the process of
References (43)
- et al.
Adult osteomyelitis
Infect Dis Clin North Am
(2005) - et al.
Acute infectious arthritis: a review of patients with nongonococcal joint infections (with emphasis on therapy and prognosis)
Am J Med
(1976) - et al.
Bacterial osteomyelitis in adults: evolving considerations in diagnosis and treatment
Am J Med
(1996) - et al.
Outpatient parenteral antimicrobial therapy technology
Infect Dis Clin North Am
(1998) - et al.
Urokinase in the management of occluded PICC lines [in French]
J Radiol
(2010) - et al.
Sutureless securement device reduces complications of peripherally inserted central venous catheters
J Vasc Interv Radiol
(2002) - et al.
Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients
Chest
(2005) - et al.
Oral step-down therapy is comparable to intravenous therapy for Staphylococcus aureus osteomyelitis
J Infect
(2007) - et al.
Linezolid-associated acute interstitial nephritis and drug rash with eosinophilia and systemic symptoms (DRESS) syndrome
Am J Kidney Dis
(2009) - et al.
Adverse effects of outpatient parenteral antibiotic therapy
Am J Med
(1999)
Clostridium difficile colitis and diarrhea
Gastroenterol Clin North Am
Osteomyelitis
N Engl J Med
Diagnosis and treatment of diabetic foot infections
Plast Reconstr Surg
Adult long bone osteomyelitis
Outpatient parenteral antimicrobial therapy today
Clin Infect Dis
Outpatient intravenous antimicrobial therapy for the practicing orthopaedic surgeon
Clin Orthop Relat Res
Practice guidelines for outpatient parenteral antimicrobial therapy: IDSA guidelines
Clin Infect Dis
Safe and successful treatment of intravenous drug users with a peripherally inserted central catheter in an outpatient parenteral antimicrobial treatment service
J Antimicrob Chemother
Systemic antimicrobial treatment
Antibiotic activities and toxicities
Cited by (12)
Recommendations for outpatient parenteral antimicrobial therapy in Brazil
2017, Brazilian Journal of Infectious DiseasesCitation Excerpt :Patients are considered eligible for OPAT when they have stabilized and do not require surgical interventions; Osteoarticular infections, including pyoarthritis, acute and chronic osteomyelitis, and orthopedic implant-related infections.5,21 The type of medication, duration of therapy, frequency of antimicrobial administration, and condition of the patient's venous network should be taken into account when determining venous access mechanisms allowed for OPAT, either using peripheral or central devices.
Clinical characteristics and outcomes of patients receiving outpatient parenteral antibiotic therapy in a Belgian setting: a single-center pilot study
2020, Acta Clinica Belgica: International Journal of Clinical and Laboratory MedicineOutcomes according to discharge location for persons who inject drugs receiving outpatient parenteral antimicrobial therapy
2018, Open Forum Infectious DiseasesPeripherally inserted central catheters in orthopedic patients: Experience from 1023 procedures
2018, Acta Ortopedica BrasileiraA novel treatment approach to infected nonunion of long bones without systemic antibiotics
2018, Strategies in Trauma and Limb Reconstruction
Individual reprints of this article and a bound reprint of the entire Symposium on Antimicrobial Therapy will be available for purchase from our Web site www.mayoclinicproceedings.org.
The Symposium on Antimicrobial Therapy will continue in an upcoming issue.