Antibiotic Therapy

In view of the rising cost of healthcare, more and more patients are opting for early discharge from hospital and choosing outpatient care to continue their treatment in a clinic or ambulatory care setting. This has the advantage of cost savings as well as convenience of being near home, as well as minimising risks of catching hospital acquired infections. However, some insurance providers have not caught up with this trend and may not cover this treatment modality.

Epidemiology

OPAT can be carried out in many settings – a private specialist clinic, a large ambulatory infusion facility, patient’s home using a home nurse or at the GP clinic. Depending on the type of treatment and the duration, patients may need a long line (central line) or a peripheral hand plug. If it is an intramuscular injection, no lines are needed.

Treatment:

The treatment usually involves intravenous or intramuscular injections with various antibiotics, ideally once or rarely twice a day. Sometimes, an antibiotic infusion pump is used and it is changed daily. Patients who can change their pumps by themselves daily need only to come in every 2 – 3 days to collect freshly prepared medicine. The nurse at our clinic will also check on the lines and change dressings as necessary.

Points to Note:

Advantages of OPAT include:
  • Early discharge from hospital and thus savings
  • Removal from an environment which may predispose to hospital acquired infections
  • Ability to spend time at home in a comfortable environment for convalescence and convenience of choosing home based or clinic based facility to administer the therapy
  • Freedom to pursue home activities and be with loved ones
  • You must be able to care for the line (central or peripheral insertion) that is placed

Clinical

OPAT have been used in the following situations:

  • Osteomyelitis (bone infection)
  • Endocarditis (Heart Valve Infection)
  • Urinary Tract Infection
  • Cellulitis (Soft tissue infection)
  • Brain Abscess
  • Pneumonia
  • Abdominal infections (including abdominal abscess, diverticulitis)
  • Tuberculosis (for treatment requiring injections)

and many other infections when intravenous or intramuscular antibiotics are preferred to oral antibiotic treatment.

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