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Silva FWL, Name LL, Tiba DY, Braz BF, Santelli RE, Canevari TC, Cincotto FH. High sensitivity, low-cost, and disposability: A novel screen-printed electrode developed for direct electrochemical detection of the antibiotic ceftriaxone. Talanta 2024; 266:125075. [PMID: 37591152 DOI: 10.1016/j.talanta.2023.125075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023]
Abstract
This study describes the development of a novel disposable and low-cost electrochemical platform for detecting the antibiotic ceftriaxone. The screen-printed electrode has been modified with a novel hybrid nanostructure containing silicon oxide (SiO2), zirconium oxide (ZrO2), and nitrogen-doped carbon quantum dots (Cdot-N). Different techniques like Fourier-transform infrared spectroscopy, Raman spectroscopy, and transmission electron microscopy characterized the hybrid nanostructure used in the sensor surface modifier material. The hybrid nanostructure showed an excellent synergistic effect that contributed to the oxidation reaction of ceftriaxone. The screen-printed electrode modified with SiO2/ZrO2/Cdot-N nanostructure presented high sensitivity with a detection limit of 0.2 nmol L-1 in the linear range of 0.0078-40.02 μmol L-1. The measurements have been performed by square wave voltammetry technique. Studies on real samples of synthetic urine, urine, and tap water showed 95%-105% recovery without applying any sample pretreatment. The sensor demonstrated excellent selectivity in the antibiotic ceftriaxone determination in the presence of possible interferences cationic, Na+, K+, Ca2+, Mg2+, Cu2+, Pb2+, Mn2+, Zn2+, Co2+, and biological, glucose, caffeine, uric acid, and ascorbic acid. The developed sensor becomes a selective, sensitive, and applicable tool in determining the antibiotic ceftriaxone.
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Affiliation(s)
- Francisco Walison Lima Silva
- Departamento de Química Analítica, Instituto de Química, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luccas L Name
- LabNaHm: Multifunctional Hybrid Nanomaterials Laboratory. Engineering School, Mackenzie Presbyterian University, 01302-907, São Paulo, SP, Brazil
| | - Daniel Y Tiba
- LabNaHm: Multifunctional Hybrid Nanomaterials Laboratory. Engineering School, Mackenzie Presbyterian University, 01302-907, São Paulo, SP, Brazil
| | - Bernardo Ferreira Braz
- Departamento de Química Analítica, Instituto de Química, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricardo Erthal Santelli
- Departamento de Química Analítica, Instituto de Química, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil; National Institute of Science & Technology of Bioanalytics (INCTBio), Campinas, Brazil
| | - Thiago C Canevari
- LabNaHm: Multifunctional Hybrid Nanomaterials Laboratory. Engineering School, Mackenzie Presbyterian University, 01302-907, São Paulo, SP, Brazil
| | - Fernando Henrique Cincotto
- Departamento de Química Analítica, Instituto de Química, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil; National Institute of Science & Technology of Bioanalytics (INCTBio), Campinas, Brazil.
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Kalatharan L, Ferman M, Kumar S, Rajendra S, Pripanapong S, Wu Y, Richards H, Rogers BA. Use of Ceftriaxone and Benzylpenicillin in Outpatient Parenteral Antimicrobial Therapy: Spectrum vs Cost. Open Forum Infect Dis 2023; 10:ofad505. [PMID: 37965641 PMCID: PMC10641299 DOI: 10.1093/ofid/ofad505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/04/2023] [Indexed: 11/16/2023] Open
Abstract
Background The application of antimicrobial stewardship (AMS) principles may entail increased cost to allow for narrower-spectrum therapy. Prescribing benzylpenicillin (BP) and ceftriaxone (CRO) for outpatient parenteral antimicrobial therapy (OPAT) demonstrates the complex challenge of this principle. The aim of this study is to analyze the use of BP and CRO in our OPAT program, including indications and relative cost. Methods We analyzed all adult patients in our OPAT program who received intravenous BP or CRO over 1 year. We identified a "crossover group" of patients who could have received either agent. Economic comparison was based on acquisition cost of the therapy (drug, infuser, and preparation costs). Results Of 105 eligible patients, 54 (51%) and 51 (49%) received BP and CRO, respectively. Forty (38%) patients were suitable for either agent; of these, the majority (n = 31, 78%) were treated with BP. Economic analysis demonstrated that the average daily cost of BP therapy was $93.76/d (AUD) vs $1.23/d for CRO. Thus, across our OPAT programs, we had an additional average cost of $92.53/patient/d to use BP instead of CRO. Program-wide the annual additional cost of using BP and thus applying this AMS strategy was $68 386.12. Conclusions BP is often selected over CRO by clinicians, where possible, as recommended by the Australian guidelines; however, BP is associated with higher daily acquisition costs. More broadly, a number of narrower-spectrum agents may involve significantly higher costs than comparators; as such, the $92.53/d to prevent CRO exposure can be considered when applying other antimicrobial-substitution AMS interventions in an acute health care setting.
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Affiliation(s)
- L Kalatharan
- Hospital in the Home, Monash Health, Clayton, Victoria, Australia
| | - M Ferman
- Hospital in the Home, Monash Health, Clayton, Victoria, Australia
| | - S Kumar
- Hospital in the Home, Monash Health, Clayton, Victoria, Australia
| | - S Rajendra
- Department of Pharmacy, Monash Health, Clayton, Victoria, Australia
| | - S Pripanapong
- Hospital in the Home, Monash Health, Clayton, Victoria, Australia
| | - Y Wu
- Hospital in the Home, Monash Health, Clayton, Victoria, Australia
| | - H Richards
- Hospital in the Home, Monash Health, Clayton, Victoria, Australia
| | - B A Rogers
- Hospital in the Home, Monash Health, Clayton, Victoria, Australia
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
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Mistry R, Rawson TM, Troise O, Mughal N, Moore LSP, Hughes S. Haematological and hepatic adverse effects of ceftriaxone in ambulatory care: a dual-centre retrospective observational analysis of standard vs high dose. BMC Infect Dis 2022; 22:959. [PMID: 36566229 PMCID: PMC9789631 DOI: 10.1186/s12879-022-07925-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/06/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoint criteria for methicillin-susceptible Staphylococcus aureus (MSSA) treatment with ceftriaxone are based upon high dose (4 g/day) rather than standard dose (2 g/day) posology. This is particularly relevant for invasive infections, and for patients managed via Outpatient Parenteral Antimicrobial Therapy (OPAT), but may result in increased drug toxicity. We quantified the incidence of neutropenia, thrombocytopenia and raised liver enzymes between standard and high dose ceftriaxone in adult patients. METHOD Adult outpatients prescribed ≥ 7 days of ceftriaxone therapy were identified, and clinical, pharmacological, and laboratory parameters extracted from electronic health records between May 2021 and December 2021. Incidence and median time to haematological and hepto-toxicity were analysed. Univariate odds ratios were calculated for neutrophil count and ALT levels with 95% confidence level and Chi squared/Fisher's exact test used to identify statistical significance. RESULTS Incidence of neutropenia was comparable between both groups; 8/47 (17%) in the 2 g group vs 6/39 (15.4%) in the 4 g group (OR 0.89 (95% CI 0.26-2.63), p > 0.999). Median time to neutropenia was 12 and 17 days in the 2 g and 4 g groups respectively. Thrombocytopenia was observed in 0/47 in the 2 g group compared with 3/39 (7.7%) in the 4 g group (p 0.089). Median time to thrombocytopenia was 7 days in the 4 g group. Elevated liver enzymes did not clearly correlate with ceftriaxone dosing; present in 5/47 (10.6%) and 2/39 (5.1%) for 2 g and 4 g respectively (OR 0.45 (95% CI 0.87-2.36), p 0.448). Treatment cessation due to any adverse effect was similar between both groups 2/47 (4.3%) for 2 g and 3/39 (7.7%) for 4 g (OR 1.86 (95% CI 0.36-10.92), p 0.655). CONCLUSIONS Increased adverse effects with 4 g (over 2 g) daily dosing of ceftriaxone was not observed in an OPAT population. However absolute development of haematological and liver dyscrasias was appreciable-monitoring of liver function and full blood count in patients receiving prolonged ceftriaxone is indicated irrespective of dosing.
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Affiliation(s)
- Rakhee Mistry
- grid.428062.a0000 0004 0497 2835Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH UK
| | - Timothy M. Rawson
- grid.428062.a0000 0004 0497 2835Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH UK ,North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF UK
| | - Oliver Troise
- grid.428062.a0000 0004 0497 2835Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH UK
| | - Nabeela Mughal
- grid.428062.a0000 0004 0497 2835Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH UK ,North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF UK ,grid.7445.20000 0001 2113 8111National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK
| | - Luke S. P. Moore
- grid.428062.a0000 0004 0497 2835Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH UK ,North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF UK ,grid.7445.20000 0001 2113 8111National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK
| | - Stephen Hughes
- grid.428062.a0000 0004 0497 2835Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH UK
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Rational Use of Ceftriaxone in Necrotizing Fasciitis and Mortality Associated with Bloodstream Infection and Hemorrhagic Bullous Lesions. Antibiotics (Basel) 2022; 11:antibiotics11111454. [PMID: 36358109 PMCID: PMC9686534 DOI: 10.3390/antibiotics11111454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022] Open
Abstract
Necrotizing fasciitis (NF) is an uncommon life-threatening necrotizing skin and soft tissue infection. The formation of hemorrhagic bullae is a special skin sign of NF. The purposes of this study were to investigate the incidence of hemorrhagic bullae formation and bacteremia associated with different organisms, to appraise the appropriate use of ceftriaxone, and to compare the clinical and laboratory risk indicators of NF patients with Gram-positive and Gram-negative infections on the initial examination. Methods: From March 2018 to December 2020, there were seventy-four NF patients with positive monomicrobial bacterial cultures enrolled based on surgical confirmation, and were categorized into two groups: the Gram-positive group and the Gram-negative group. Ceftriaxone susceptibility tests were carried out using the standard disk diffusion technique. Data, such as demographics, clinical outcomes, microbiological results, presentations of hemorrhagic bullae, and laboratory findings, were compared among these two groups. Results: The Gram-negative group included 52 patients, of whom 6 patients died, resulting in a mortality rate of 11.5%. The Gram-positive group included 22 patients and none died. Patients with bacteremia, hemorrhagic bullae, shock, fever, higher segmented forms and banded forms, and lower platelet counts constituted higher proportions in the Gram-negative group than in the Gram-positive group. The multivariate analysis identified six variables for the differentiation of Gram-negative and Gram-positive NF: the presentation of bacteremia, hemorrhagic bullae, shock at first consultation, fever with body temperature > 38.5 °C, band forms > 0%, and segmented forms ≦ 74%. A total of 66 isolates (89.2%) was susceptible to ceftriaxone. Conclusions: Gram-negative NF patients were significantly associated with hemorrhagic bullae presentation, blood stream infection, and mortality. Physicians should be alert to NF patients with the appearance of bacteremia, shock, fever, higher WBC banded and segmented forms, and lower platelet counts at the emergency department, with patients revealed to more likely have Gram-negative infections. Ceftriaxone with/without other appropriate antibiotics under the supervision of infectious doctors appeared to be clinically effective for the treatment of NF and blood stream infections.
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Shuja SH, Naeem U, Eqbal F, Shuja MH. Ceftriaxone - A plausible intervention for treating neurosyphilis? Ann Med Surg (Lond) 2022; 82:104662. [PMID: 36268347 PMCID: PMC9577590 DOI: 10.1016/j.amsu.2022.104662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/10/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Syed Hasan Shuja
- Dow Medical College, Dow University of Health Sciences, Baba e urdu road, Saddar, Karachi, Pakistan
| | - Unaiza Naeem
- Dow Medical College, Dow University of Health Sciences, Baba e urdu road, Saddar, Karachi, Pakistan
| | - Farea Eqbal
- Dow Medical College, Dow University of Health Sciences, Baba e urdu road, Saddar, Karachi, Pakistan
| | - Muhammad Hamza Shuja
- Dow Medical College, Dow University of Health Sciences, Baba e urdu road, Saddar, Karachi, Pakistan
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Kuiper SG, Ploeger M, Wilms EB, van Dijk MM, Leegwater E, Huis in’t Veld RAG, van Nieuwkoop C. Ceftriaxone for the Treatment of Chronic Bacterial Prostatitis: A Case Series and Literature Review. Antibiotics (Basel) 2022; 11:83. [PMID: 35052960 PMCID: PMC8772798 DOI: 10.3390/antibiotics11010083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 12/22/2022] Open
Abstract
Chronic bacterial prostatitis is increasingly difficult to treat due to rising antimicrobial resistance limiting oral treatment options. In this case series, 11 men with CBP (including patients with urological comorbidities) due to multi-resistant E. coli were treated with once-daily ceftriaxone intravenously for 6 weeks. Nine patients were clinically cured at 3 months follow up. No early withdrawal of medication due to side effects occurred. A literature review was conducted to describe the prostate pharmacokinetics of ceftriaxone and its use in prostatic infection. In conclusion, ceftriaxone can be considered an appropriate treatment of chronic bacterial prostatitis.
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Affiliation(s)
- Sander G. Kuiper
- Department of Internal Medicine, Haga Teaching Hospital, 2545 AA The Hague, The Netherlands;
| | - Maarten Ploeger
- Department of Hospital Pharmacy, Haga Teaching Hospital, 2545 AA The Hague, The Netherlands; (M.P.); (E.B.W.); (E.L.)
| | - Erik B. Wilms
- Department of Hospital Pharmacy, Haga Teaching Hospital, 2545 AA The Hague, The Netherlands; (M.P.); (E.B.W.); (E.L.)
| | - Marleen M. van Dijk
- Department of Urology, Haga Teaching Hospital, 2545 AA The Hague, The Netherlands;
| | - Emiel Leegwater
- Department of Hospital Pharmacy, Haga Teaching Hospital, 2545 AA The Hague, The Netherlands; (M.P.); (E.B.W.); (E.L.)
| | - Robert A. G. Huis in’t Veld
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Cees van Nieuwkoop
- Department of Internal Medicine, Haga Teaching Hospital, 2545 AA The Hague, The Netherlands;
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The Overlooked Issue of Outpatient Combination Antibiotic Prescribing in Low- and Middle-Income Countries: An Example from Syria. Antibiotics (Basel) 2022; 11:antibiotics11010074. [PMID: 35052951 PMCID: PMC8772973 DOI: 10.3390/antibiotics11010074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/02/2022] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
This study aimed to determine and describe the prevalence of combination antibiotics dispensed in outpatients with health insurance in Syria. Data on all dispensed medicines between June 2018 and May 2019 for 81,314 adults were obtained, and medicines belonging to the J01 group of the World Health Organization (WHO) anatomical therapeutic classification (ATC) were included in the analysis. Prescriptions were stratified according to the number of antibiotics, age, and sex. Antibiotic utilization was expressed as the number of prescriptions per 1000 persons per year. Out of 59,404 prescriptions for antibiotics, 14.98% contained antibiotic combinations, distributed to 22.49% of the patients. The prevalence of dispensing antibiotic combinations was higher in female patients (23.00%), and the youngest (18–30 years, 26.19%) and oldest age groups (>70 years, 25.19%). The antibiotics most commonly combined were co-amoxiclav, second- and third-generation cephalosporins, and macrolides. Over 60% of the combinations contained ceftriaxone alone or in combination with sulbactam. The present study shows an alarmingly widespread prescription of antibiotic combinations, posing a risk to global health by promoting resistance development.
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Amare F, Gashaw T, Sisay M, Baye Y, Tesfa T. The appropriateness of ceftriaxone utilization in government hospitals of Eastern Ethiopia: A retrospective evaluation of clinical practice. SAGE Open Med 2021; 9:20503121211051525. [PMID: 34691471 PMCID: PMC8532238 DOI: 10.1177/20503121211051525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Drug use evaluation is a method of obtaining information to identify problems related to drug use and if properly developed, a means of correcting the problems. Ceftriaxone is among the most commonly utilized cephalosporins. Owing to a broad spectrum of activity and being used empirically, ceftriaxone has been used inappropriately posing a risk for development of antimicrobial resistance. This study is, therefore, designed to evaluate the appropriateness of ceftriaxone utilization in government hospitals in Harar town. Methods: A retrospective cross-sectional study was conducted in four government hospitals of Harar town by reviewing the medical records of 271 patients who received ceftriaxone from 1 January to 31 December 2016. Systematic random sampling was utilized to capture the medical records. Data were entered and analyzed using SPSS version 22. Results: From the 271 medical records reviewed majority of patients were from surgical ward (n = 85, 31.4%) followed by gynecology and obstetrics ward (n = 67, 24.7%). Demographically, the majority of the patients were female (n = 142, 52.4%). Patients in the age group of 20–29 years were dominant (n = 98, 36.2%). A total of 71 drugs were co-administered with ceftriaxone, the most common being metronidazole followed by tramadol. Among the co-administered drugs, unfractionated heparin (n = 6), warfarin (n = 5), and enoxaparin (n = 1) were found to have a moderate drug interaction with ceftriaxone. Ceftriaxone was commonly used for post-operative prophylaxis (n = 80, 27.5%) followed by for the management of pneumonia (n = 62, 21.3%). The result of ceftriaxone use evaluation showed that majority (n = 190, 70.1%) were found to be inappropriate. The inappropriate utilization was primarily due to wrong indication (indications for which ceftriaxone was not the primary option) (n = 114, 60.0%) followed by wrong duration (n = 54, 28.4%). Conclusion: Ceftriaxone was used inappropriately in more than two-thirds of the patients, with wrong indication and wrong duration contributing the majority. Inappropriate use of antibiotics may potentially lead to the emergence and spread of drug-resistant microorganisms and also ultimately exposes the patient to treatment failure, prolonged hospital stay, and higher cost of therapy.
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Affiliation(s)
- Firehiwot Amare
- Clinical Pharmacy Unit, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tigist Gashaw
- Pharmacology and Toxicology Unit, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mekonnen Sisay
- Pharmacology and Toxicology Unit, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yohannes Baye
- Department of Pediatrics and Neonatal Nursing, School of Nursing, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tewodros Tesfa
- Microbiology Unit, Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Bettuzzi T, Jourdes A, Robineau O, Alcaraz I, Manda V, Molina JM, Mehlen M, Cazanave C, Tattevin P, Mensi S, Terrier B, Régent A, Ghosn J, Charlier C, Martin-Blondel G, Dupin N. Ceftriaxone compared with benzylpenicillin in the treatment of neurosyphilis in France: a retrospective multicentre study. THE LANCET. INFECTIOUS DISEASES 2021; 21:1441-1447. [PMID: 34051142 DOI: 10.1016/s1473-3099(20)30857-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/10/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Intravenous benzylpenicillin is the gold-standard treatment for neurosyphilis, but it requires prolonged hospitalisation. Ceftriaxone is a possible alternative treatment, the effectiveness of which remains unclear. We aimed to assess the effectiveness of ceftriaxone compared with benzylpenicillin in the treatment of neurosyphilis. METHODS We did a retrospective multicentre study including patients with neurosyphilis who were treated at one of eight tertiary care centres in France, from Jan 1, 1997, to Dec 31, 2017. We defined neurosyphilis as positive treponemal and non-treponemal tests and at least one of otic syphilis, ocular syphilis, either neurological symptom with a positive result on cerebrospinal fluid (CSF)-VDRL or CSF-PCR tests, or more than five leukocytes in a CSF cell count. Patients with neurosyphilis were identified from the medical information department database of each centre and assigned to one of two groups on the basis of the initial treatment received (ie, benzylpenicillin group or ceftriaxone group). The primary outcome was the overall clinical response (ie, proportion of patients with a complete or partial response) 1 month after treatment initiation. The secondary endpoints were proportions of patients with a complete response at 1 month and serological response at 6 months, and length of hospital stay. FINDINGS Of 365 patients with a coded diagnosis of neurosyphilis in one of the eight care centres during 1997-2017, 208 were included in this study (42 in the ceftriaxone group and 166 in the benzylpenicillin group). The mean age of patients was 44·4 years (SD 13·4), and 193 (93%) were men. We observed 41 instances of overall clinical response (98%) in the ceftriaxone group versus 125 (76%) in the benzylpenicillin group (crude odds ratio [OR] 13·02 [95% CI 1·73-97·66], p=0·017). After propensity score weighting, overall clinical response rates remained different between the groups (OR 1·22 [95% CI 1·12-1·33], p<0·0001). 22 (52%) patients in the ceftriaxone group and 55 (33%) in the benzylpenicillin group had a complete response (crude OR 2·26 [95% CI 1·12-4·41], p=0·031), with no significant difference after propensity score weighting (OR 1·08 [95% CI 0·94-1·24], p=0·269). Serological response at 6 months did not differ between the groups (21 [88%] of 24 in the ceftriaxone group vs 76 [82%] of 93 in the benzylpenicillin group; crude OR 1·56 [95% CI 0·42-5·86], p=0·50), whereas hospital stay was shorter for patients in the ceftriaxone group than for those in the benzylpenicillin group (mean 13·8 days [95% CI 12·8-14·8] vs 8·9 days [5·7-12·0], p<0·0001). No major adverse effects were reported in either group. INTERPRETATION Our results suggest that ceftriaxone is similarly effective to benzylpenicillin for the treatment of neurosyphilis, potentially decreasing the length of hospital stay. Randomised, controlled trials should be done to confirm these results. FUNDING None.
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Affiliation(s)
- Thomas Bettuzzi
- Service de Dermatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; EpiDermE, University Paris Est Créteil, Créteil, France
| | - Aurélie Jourdes
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Olivier Robineau
- Service Universitaire des Maladies Infectieuses et du Voyageur, Hôpital Dron, Tourcoing, France
| | - Isabelle Alcaraz
- Service Universitaire des Maladies Infectieuses et du Voyageur, Hôpital Dron, Tourcoing, France
| | - Victoria Manda
- Département des Maladies Infectieuses, Hôpital Saint Louis et Lariboisière, AP-HP, Paris, France; Université de Paris, Paris, France
| | - Jean Michel Molina
- Département des Maladies Infectieuses, Hôpital Saint Louis et Lariboisière, AP-HP, Paris, France; Université de Paris, Paris, France
| | - Maxime Mehlen
- Service de Maladies Infectieuses, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Charles Cazanave
- Service de Maladies Infectieuses, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Pierre Tattevin
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Sami Mensi
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alexis Régent
- Service de Médecine Interne, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jade Ghosn
- Service de Maladies Infectieuses, Hôpital Bichat, AP-HP, Paris, France
| | - Caroline Charlier
- Université de Paris, Paris, France; Service de Maladies Infectieuses, Hôpital Necker, AP-HP, Paris, France
| | - Guillaume Martin-Blondel
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INSERM UMR 1291 - CNRS UMR 5051, Toulouse Institute for Infectious and Inflammatory Diseases, Université Toulouse III, Toulouse, France
| | - Nicolas Dupin
- Service de Dermatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Centre National de Référence de la Syphilis, Institut Cochin, Unité Inserm U1016, Université de Paris, Paris, France.
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10
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Farmer ECW, Seaton RA. Recent innovations and new applications of outpatient parenteral antimicrobial therapy. Expert Rev Anti Infect Ther 2020; 19:55-64. [PMID: 32799577 DOI: 10.1080/14787210.2020.1810566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Outpatient parenteral antimicrobial therapy (OPAT) is safe and effective for selected patients managed within an organized clinical service. Service configurations however are evolving, patient populations are changing and new evidence is emerging which challenges traditional OPAT practice. AREAS COVERED This review will discuss evolving OPAT service delivery from the traditional model of infusion center toward nonspecialist, community and remotely delivered OPAT and the challenges this represents. We consider new patient populations including those with incurable infection or infections at the end of life and difficult to reach populations including people who inject drugs. The evidence base that underpins the multi-disciplinary approach to OPAT delivery will be examined and particularly the role of the antimicrobial pharmacist and specialist nurse. Evidence for new treatment options which challenge established OPAT practice including complex oral antibiotic regimens, long acting parenteral agents and drug stability in continuous infusion antibiotics will be considered. Finally we emphasize the central importance of antimicrobial stewardship and good clinical governance which should underpin OPAT practice. EXPERT OPINION Changing patient populations, service structures and team roles coupled with a growing infection management evidence base means that OPAT services and practice must evolve. Challenging traditional practice is essential to ensure best patient outcomes and cost-efficiency.
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Affiliation(s)
| | - Ronald Andrew Seaton
- Infectious Disease Department, Queen Elizabeth University Hospital , Glasgow, UK
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Wo S, Dubrovskaya Y, Siegfried J, Papadopoulos J, Jen SP. Clinical Outcomes of Ceftriaxone vs Penicillin G for Complicated Viridans Group Streptococci Bacteremia. Open Forum Infect Dis 2020; 8:ofaa542. [PMID: 33511221 PMCID: PMC7817077 DOI: 10.1093/ofid/ofaa542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/03/2020] [Indexed: 11/20/2022] Open
Abstract
Background Ceftriaxone (CTX) and penicillin G (PCN G) are considered reasonable treatment options for viridans group streptococci (VGS) bloodstream infections, but comparisons between these agents are limited. We evaluated clinical outcomes among patients treated with these agents for complicated VGS bacteremia. Methods This was a single-center retrospective study of adult patients with ≥1 positive VGS blood culture who were treated with either CTX or PCN G/ampicillin (both included in the PCN arm) between January 2013 and June 2019. The primary outcome was a composite of safety end points, including hospital readmission due to VGS bacteremia or adverse events (AEs) from therapy, Clostridioides difficile infections, treatment modification or discontinuation due to AEs from therapy, and development of extended-spectrum beta-lactamase resistance. Secondary outcomes included individual safety end points, VGS bacteremia recurrence, hospital readmission, and all-cause mortality. Results Of 328 patients screened, 94 met eligibility criteria (CTX n = 64, PCN n = 30). Streptococcus mitis was the most common isolate, and infective endocarditis was the predominant source of infection. CTX was not significantly associated with increased risk of the primary composite safety outcome (CTX 14% vs PCN 27%; P = .139). The driver of the composite outcome was hospital readmission due to VGS bacteremia or therapy complications. No secondary end points differed significantly between groups. On multivariate analysis, source removal was a protective factor of the primary composite safety outcome. Conclusions Despite potential safety concerns with the prolonged use of CTX in complicated VGS bacteremia, this study did not demonstrate higher rates of treatment failure, adverse events, or resistance.
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Affiliation(s)
- Stephanie Wo
- Department of Pharmacy, NYU Langone Health, New York, New York, USA
| | - Yanina Dubrovskaya
- Department of Pharmacy, NYU Langone Health, New York, New York, USA.,Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Justin Siegfried
- Department of Pharmacy, NYU Langone Health, New York, New York, USA
| | - John Papadopoulos
- Department of Pharmacy, NYU Langone Health, New York, New York, USA.,Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Shin-Pung Jen
- Department of Pharmacy, Newark Beth Israel Medical Center, Newark, New Jersey, USA
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Kamfose MM, Muriithi FG, Knight T, Lasserson D, Hayward G. Intravenous Ceftriaxone Versus Multiple Dosing Regimes of Intravenous Anti-Staphylococcal Antibiotics for Methicillin-Susceptible Staphylococcus aureus (MSSA): A Systematic Review. Antibiotics (Basel) 2020; 9:antibiotics9020039. [PMID: 31972972 PMCID: PMC7169384 DOI: 10.3390/antibiotics9020039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 01/21/2023] Open
Abstract
Background: Methicillin-susceptible Staphylococcus aureus (MSSA) is a common pathogen associated with a range of clinically important infections. MSSA can cause deep-seated infections requiring prolonged courses of intravenous antibiotic therapy to achieve effective resolution. The move toward ambulatory or outpatient delivery of parenteral antibiotics has led to an increase in the use of ceftriaxone as a pragmatic first choice given its advantageous single daily dosing schedule. Objective: To compare the efficacy of once daily ceftriaxone in the treatment of infections due to confirmed or suspected MSSA to multiple dosing regimes of anti-staphylococcal antibiotics. Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Global Health, PubMed, EMBASE and CINAHL for randomised controlled trials as well as prospective and retrospective cohort studies that compared ceftriaxone to any multiple dosing regime of anti-staphylococcal antibiotics. Outcome measures were the proportion of patients with a resolution of infection based on time after initiation of therapy, adverse reactions, recurrence and duration of hospital admission. Results: We included two randomized controlled trials, one prospective observational study and three retrospective cohort studies (643 participants; 246 children, 397 adults). There was no difference in time to resolution of symptoms. The number of adverse reactions, recurrence of bacteraemia and duration of hospital stay were not significantly different between ceftriaxone and other anti-staphylococcal antibiotics. Conclusions: Based on a small number of low-quality studies, ceftriaxone is as effective as multiple dosing regimes for the treatment of infections due MSSA. An appropriately powered randomized trial is required to demonstrate equivalence and cost effectiveness.
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Affiliation(s)
- Musaiwale M. Kamfose
- Department of Infection Control and Microbiology, John Radcliffe Hospital, Headley Way, Oxford OX3 7JS, UK
- Correspondence: ; Tel.: +44-018-6522-2884
| | - Francis G. Muriithi
- Obstetrics and Gynaecology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Derby Rd, Nottingham NG7 2UH, UK;
| | - Thomas Knight
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK; (T.K.); (D.L.)
| | - Daniel Lasserson
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK; (T.K.); (D.L.)
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK;
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Chapman ALN, Patel S, Horner C, Green H, Guleri A, Hedderwick S, Snape S, Statham J, Wilson E, Gilchrist M, Seaton RA. Updated good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults and children in the UK. JAC Antimicrob Resist 2019; 1:dlz026. [PMID: 34222901 PMCID: PMC8209972 DOI: 10.1093/jacamr/dlz026] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
UK good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) were published in 2012 and 2015 for adult and paediatric patients, respectively. Here we update the initial good practice recommendations in a combined document based on a further review of the OPAT literature and an extensive consultation process. As with the previous good practice recommendations, these updated recommendations are intended to provide pragmatic guidance for new and established OPAT services across a range of settings and to act as a set of quality indicators for service evaluation and quality improvement.
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Affiliation(s)
| | - Sanjay Patel
- Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Carolyne Horner
- The British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Helen Green
- Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Achyut Guleri
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | | | - Susan Snape
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Julie Statham
- South Warwickshire NHS Foundation Trust, Warwick, UK
| | | | | | - R Andrew Seaton
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
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Hatcher J, Costelloe C, Cele R, Viljanen A, Samarasinghe D, Satta G, Brannigan E, De Barra E, Sanderson F, Gilchrist M. Factors associated with successful completion of outpatient parenteral antibiotic therapy (OPAT): A 10-year review from a large West London service. Int J Antimicrob Agents 2019; 54:207-214. [PMID: 30986525 DOI: 10.1016/j.ijantimicag.2019.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 04/02/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
Abstract
Outpatient parenteral antibiotic therapy (OPAT) is an established antimicrobial delivery method in the UK. OPAT services differ nationwide, with a paucity of high-quality outcome data to enable benchmarking. A retrospective review of clinical outcomes and adverse events (AEs) of all patients treated during 2008-2017 was performed to identify factors associated with success and failure. Regression models were used to identify factors associated with OPAT success, and AEs were described for the study population using definitions recommended by BSAC. In the 10-year period, 2870 patient episodes resulted in 69 610 days of treatment, with a 91.7% rate of successful therapy completion and 92.0% of infections cured or improved. We encountered 196 AEs, including 1 case of Clostridium difficile-associated diarrhoea. AEs occurred in 10.9% of patient episodes. Adverse drug and line events occurred at a rate of 3.3 and 1.78 per 1000 treatment days, respectively. Rashes, blood dyscrasias and hepatitis were the most common drug AEs. The odds of OPAT success was greater for patients who spent more time (>14 days) on OPAT therapy (OR = 2.32; P < 0.01), utilised a peripheral line (OR = 1.83; P < 0.01), were treated in the clinic compared with self-administration (OR = 2.1; P < 0.02) and did not experience an AE (OR = 0.23; P < 0.01). In our setting, the odds of a successful OPAT episode were associated with longer treatment course, OPAT delivered via a peripheral line, administration in an OPAT clinic setting, and no adverse line or drug events.
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Affiliation(s)
- James Hatcher
- Department of Infection, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - Ceire Costelloe
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Richard Cele
- Department of Infection, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - Anu Viljanen
- Department of Infection, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - Dunisha Samarasinghe
- Department of Infection, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - Giovanni Satta
- Department of Infection, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - Eimear Brannigan
- Department of Infection, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - Eoghan De Barra
- Department of Infection, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - Frances Sanderson
- Department of Infection, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - Mark Gilchrist
- Department of Infection, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK.
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Bondarenko S, Chang CB, Cordero-Ampuero J, Kates S, Kheir M, Klement MR, McPherson E, Morata L, Silibovsky R, Skaliczki G, Soriano A, Suárez R, Szatmári A, Webb J, Young S, Zimmerli W. General Assembly, Prevention, Antimicrobials (Systemic): Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S61-S73. [PMID: 30348584 DOI: 10.1016/j.arth.2018.09.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Outpatient parenteral antimicrobial therapy and antibiotic stewardship: opponents or teammates? Infection 2018; 47:169-181. [PMID: 30443780 DOI: 10.1007/s15010-018-1250-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/09/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE This narrative review aims to describe barriers of outpatient parenteral antimicrobial therapy at home (OPAT), potentially compromising general standards of antibiotic stewardship (ABS) and facilitators of OPAT for ABS. METHODS After a literature review, five authors determined the barriers and facilitators to discuss in this review. RESULTS Sixty-six publications were included in the narrative review and seven barriers and five facilitators are discussed in this article. The impracticability of multiple daily dosing during OPAT, the impact of real-life temperature variations, deviations of the infusion rates of elastomeric devices, access to prolonged intravenous antibiotic therapy, not administering loading doses before the initiation of extended or continuous infusions and the transmural nature of care associated with OPAT, can lead to deviations of recommended treatment regimens and sub-optimal clinical and laboratory follow-up, with a risk of inferior clinical outcomes, adverse events, drug-resistance and higher costs. On the other hand, OPAT provides access to treatments with intravenous antibiotics and simultaneously avoids prolonged hospitalization. CONCLUSION Implementing ABS guidelines in OPAT programs, e.g., by using a multidisciplinary team approach and facility-specific protocols for OPAT with patient selection criteria and instructions for selection, storage, preparation and administration of antibiotics, can improve appropriate antibiotic use. Additionally, further research should examine the effectiveness of these interventions on outcomes of OPAT.
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Al-Saadi MA, Sultan SSN. Effect of Ceftriaxone versus Amoxicillin + Clavulanic Acid for Treatment of Acute Bacterial Rhino Sinusitis: Short Course Therapy. Open Access Maced J Med Sci 2018; 6:1419-1422. [PMID: 30159068 PMCID: PMC6108821 DOI: 10.3889/oamjms.2018.329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 07/22/2018] [Accepted: 07/27/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Acute bacterial rhinosinusitis is one of upper respiratory tract infection that disturbs patient life and requires special consideration. AIM: To evaluate the efficiency of Ceftriaxone versus a high dose of Amoxicillin-clavulanic acid for the treatment of acute bacterial rhinosinusitis. PATIENTS AND METHOD: Observational retrospective study include120 patients of both sex classified into two groups equally conducted. G1 treated with Ceftriaxone 1 g intramuscular injection once daily while, G2 treated with oral Amoxicillin-clavulanic acid (875 mg/125 mg) twice daily for 3-4 days then, the outcome of treatment evaluated as a cure or failed at the fifth or fourth day of treatment. RESULTS: Significant cure response observed in Ceftriaxone treated patient’s P ≤ 0.05 and significant failure response observed in Amoxicillin-clavulanic acid-treated patients when groups compared with each other. About gender and age groups, no significant differences in number between group 1 and 2 P ≥ 0.05. CONCLUSION: Ceftriaxone found more effective in the treatment of acute bacterial sinusitis than Amoxicillin+ clavulanic acid. Amoxicillin+clavulanic acid associated with more male failure cases recorded than female.
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Affiliation(s)
- Malath Azeez Al-Saadi
- Pharmacology and Toxicology, College of Dentistry, University of Babylon, Hilla, Iraq
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Actinomyces europaeus Isolated from a Breast Abscess in a Penicillin-Allergic Patient. Case Rep Infect Dis 2018; 2018:6708614. [PMID: 30026992 PMCID: PMC6031163 DOI: 10.1155/2018/6708614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 01/22/2023] Open
Abstract
This is a case of Actinomyces europaeus in the breast abscess of a penicillin-allergic woman. The mainstay of treatment for actinomycosis is penicillin, and there is a lack of literature describing nonpenicillin treatment options. A 69-year-old woman presented acutely with a breast abscess which was managed with incision and drainage and antibiotic therapy to good response. 21 days after presentation, Actinomyces were grown from the culture of pus, so the patient was recalled and more rigorous treatment and follow-up were initiated. The penicillin allergy led to difficulty in the identification of an appropriate antimicrobial agent that was also logistically feasible to be given on an outpatient IV basis. IV tigecycline followed by oral clarithromycin was found to be effective treatment.
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Triffault-Fillit C, Ferry T, Perpoint T, Adélaïde L, Le Ngoc Tho S, Ader F, Chidiac C, Valour F. Outpatient parenteral antibiotic therapy: Evaluation of practices and limits of use in rural areas in France. Med Mal Infect 2017; 48:130-135. [PMID: 29050864 DOI: 10.1016/j.medmal.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 01/07/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate outpatient parenteral antibiotic therapy (OPAT) practices in a French rural area. MATERIAL AND METHODS Descriptive study assessing knowledge, practices, and limitations of OPAT use among hospital practitioners (HP), family physicians (FP), and private nurses (PN). RESULTS OPAT (mainly ceftriaxone and penicillins) was used by 69.6%, 73.3%, and 97.7% of the 23 HPs, 45 FPs, and 46 PNs mostly for respiratory or urinary tract infections, bacteremia, and/or multidrug-resistant bacterial infections. Overall, 65.2% of HPs and 37.8% of FPs were in contact with an infectious disease specialist. Knowledge of OPAT benefits and risks was lower for FPs than HPs. The main obstacles were the patient's geographic isolation (HPs), the availability of a venous catheter, the lack of training (FPs), and the expected OPAT-associated overwork (PNs). CONCLUSION OPAT practice is weak in rural areas. Declared obstacles constitute fields of improvement for its essential expansion.
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Affiliation(s)
- C Triffault-Fillit
- Service des maladies infectieuses et tropicales, CRIOAc Lyon, hospices civils de Lyon, Lyon, France; Département de médecine générale, université Claude-Bernard Lyon 1, Lyon, France
| | - T Ferry
- Service des maladies infectieuses et tropicales, CRIOAc Lyon, hospices civils de Lyon, Lyon, France; Inserm U1111, centre international de recherche en infectiologie (CIRI), université Claude-Bernard Lyon 1, Lyon, France
| | - T Perpoint
- Service des maladies infectieuses et tropicales, CRIOAc Lyon, hospices civils de Lyon, Lyon, France
| | - L Adélaïde
- Service des maladies infectieuses et tropicales, CRIOAc Lyon, hospices civils de Lyon, Lyon, France
| | - S Le Ngoc Tho
- Département de médecine générale, université Claude-Bernard Lyon 1, Lyon, France
| | - F Ader
- Service des maladies infectieuses et tropicales, CRIOAc Lyon, hospices civils de Lyon, Lyon, France; Inserm U1111, centre international de recherche en infectiologie (CIRI), université Claude-Bernard Lyon 1, Lyon, France
| | - C Chidiac
- Service des maladies infectieuses et tropicales, CRIOAc Lyon, hospices civils de Lyon, Lyon, France; Inserm U1111, centre international de recherche en infectiologie (CIRI), université Claude-Bernard Lyon 1, Lyon, France
| | - F Valour
- Service des maladies infectieuses et tropicales, CRIOAc Lyon, hospices civils de Lyon, Lyon, France; Inserm U1111, centre international de recherche en infectiologie (CIRI), université Claude-Bernard Lyon 1, Lyon, France.
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Durojaiye OC, Bell H, Andrews D, Ntziora F, Cartwright K. Clinical efficacy, cost analysis and patient acceptability of outpatient parenteral antibiotic therapy (OPAT): a decade of Sheffield (UK) OPAT service. Int J Antimicrob Agents 2017; 51:26-32. [PMID: 28673610 DOI: 10.1016/j.ijantimicag.2017.03.016] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 03/10/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) has evolved relatively slowly in the UK. This study describes the OPAT service based in a large UK teaching hospital in Sheffield, and examines the clinical efficacy, patient acceptability and costs saved over a 10-year period. Data on 3812 episodes of OPAT administered between January 2006 and January 2016 were retrieved from a prospectively maintained electronic database. This study compared the real costs of the OPAT service with estimated costs of conventional inpatient care for these patient episodes, and analysed patient feedback questionnaires that were administered randomly between January 2014 and January 2015. A wide range of infections were managed during the 10-year period. Skin and soft tissue infections accounted for 57% of OPAT episodes. The total number of bed-days saved was 49,854. A successful outcome (cure or improvement) was found in 3357 (88%) episodes. Re-admission occurred in 265 (7%) episodes. The rates of healthcare-associated infections were low: 15 intravenous-line-related infections were recorded (0.3 per 1000 OPAT patient-days). Patient acceptance and satisfaction with OPAT were high. OPAT cost 15%, 39%, 40% and 44% of inpatient costs for an infectious diseases unit, national average costs, other departments (non-infectious diseases unit), and the minimum national average costs for each diagnostic category, respectively. This study shows that OPAT is safe, clinically efficacious and acceptable for treating a wide range of infections with high levels of patient satisfaction and substantial cost savings.
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Affiliation(s)
| | - Helen Bell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Dawn Andrews
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, UK
| | - Fotinie Ntziora
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, UK
| | - Katharine Cartwright
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, UK
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Mitchell ED, Czoski Murray C, Meads D, Minton J, Wright J, Twiddy M. Clinical and cost-effectiveness, safety and acceptability of community intra venous antibiotic service models: CIVAS systematic review. BMJ Open 2017; 7:e013560. [PMID: 28428184 PMCID: PMC5775457 DOI: 10.1136/bmjopen-2016-013560] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Evaluate evidence of the efficacy, safety, acceptability and cost-effectiveness of outpatient parenteral antimicrobial therapy (OPAT) models. DESIGN A systematic review. DATA SOURCES MEDLINE, EMBASE, CINAHL, Cochrane Library, National Health Service (NHS) Economic Evaluation Database (EED), Research Papers in Economics (RePEc), Tufts Cost-Effectiveness Analysis (CEA) Registry, Health Business Elite, Health Information Management Consortium (HMIC), Web of Science Proceedings, International Pharmaceutical Abstracts, British Society for Antimicrobial Chemotherapy website. Searches were undertaken from 1993 to 2015. STUDY SELECTION All studies, except case reports, considering adult patients or practitioners involved in the delivery of OPAT were included. Studies combining outcomes for adults and children or non-intravenous (IV) and IV antibiotic groups were excluded, as were those focused on process of delivery or clinical effectiveness of 1 antibiotic over another. Titles/abstracts were screened by 1 reviewer (20% verified). 2 authors independently screened studies for inclusion. RESULTS 128 studies involving >60 000 OPAT episodes were included. 22 studies (17%) did not indicate the OPAT model used; only 29 involved a comparator (23%). There was little difference in duration of OPAT treatment compared with inpatient therapy, and overall OPAT appeared to produce superior cure/improvement rates. However, when models were considered individually, outpatient delivery appeared to be less effective, and self-administration and specialist nurse delivery more effective. Drug side effects, deaths and hospital readmissions were similar to those for inpatient treatment, but there were more line-related complications. Patient satisfaction was high, with advantages seen in being able to resume daily activities and having greater freedom and control. However, most professionals perceived challenges in providing OPAT. CONCLUSIONS There were no systematic differences related to the impact of OPAT on treatment duration or adverse events. However, evidence of its clinical benefit compared with traditional inpatient treatment is lacking, primarily due to the dearth of good quality comparative studies. There was high patient satisfaction with OPAT use but the few studies considering practitioner acceptability highlighted organisational and logistic barriers to its delivery.
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Affiliation(s)
- E D Mitchell
- Centre for Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - C Czoski Murray
- Centre for Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - D Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - J Minton
- Department of Infection and Travel Medicine, Leeds Teaching Hospitals NHS Trust, St James's Hospital, Leeds, UK
| | - J Wright
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - M Twiddy
- Centre for Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Minton J, Murray CC, Meads D, Hess S, Vargas-Palacios A, Mitchell E, Wright J, Hulme C, Raynor DK, Gregson A, Stanley P, McLintock K, Vincent R, Twiddy M. The Community IntraVenous Antibiotic Study (CIVAS): a mixed-methods evaluation of patient preferences for and cost-effectiveness of different service models for delivering outpatient parenteral antimicrobial therapy. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BackgroundOutpatient parenteral antimicrobial therapy (OPAT) is widely used in most developed countries, providing considerable opportunities for improved cost savings. However, it is implemented only partially in the UK, using a variety of service models.ObjectivesThe aims of this research were to (1) establish the extent of OPAT service models in England and identify their development; (2) evaluate patients’ preferences for different OPAT service delivery models; (3) assess the cost-effectiveness of different OPAT service delivery models; and (4) convene a consensus panel to consider our evidence and make recommendations.MethodsThis mixed-methods study included seven centres providing OPAT using four main service models: (1) hospital outpatient (HO) attendance; (2) specialist nurse (SN) visiting at home; (3) general nurse (GN) visiting at home; and (4) self-administration (SA) or carer administration. Health-care providers were surveyed and interviewed to explore the implementation of OPAT services in England. OPAT patients were interviewed to determine key service attributes to develop a discrete choice experiment (DCE). This was used to perform a quantitative analysis of their preferences and attitudes. Anonymised OPAT case data were used to model cost-effectiveness with both Markov and simulation modelling methods. An expert panel reviewed the evidence and made recommendations for future service provision and further research.ResultsThe systematic review revealed limited robust literature but suggested that HO is least effective and SN is most effective. Qualitative study participants felt that different models of care were suited to different types of patient and they also identified key service attributes. The DCE indicated that type of service was the most important factor, with SN being strongly preferred to HO and SA. Preferences were influenced by attitudes to health care. The results from both Markov and simulation models suggest that a SN model is the optimal service for short treatment courses (up to 7 days). Net monetary benefit (NMB) values for HO, GN and SN services were £2493, £2547 and £2655, respectively. For longer treatment, SA appears to be optimal, although SNs provide slightly higher benefits at increased cost. NMB values for HO, GN, SN and SA services were £8240, £9550, £10,388 and £10,644, respectively. The simulation model provided useful information for planning OPAT services. The expert panel requested more guidance for service providers and commissioners. Overall, they agreed that mixed service models were preferable.LimitationsRecruitment to the qualitative study was suboptimal in the very elderly and ethnic minorities, so the preferences of patients from these groups might not be represented. The study recruited from Yorkshire, so the findings may not be applicable nationally.ConclusionsThe quantitative preference analysis and economic modelling favoured a SN model, although there are differences between sociodemographic groups. SA provides cost savings for long-term treatment but is not appropriate for all.Future workFurther research is necessary to replicate our results in other regions and populations and to evaluate mixed service models. The simulation modelling and DCE methods used here may be applicable in other health-care settings.FundingThe National Institute for Health Research Health Service and Delivery Research programme.
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Affiliation(s)
- Jane Minton
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Stephane Hess
- Institute of Transport Studies, University of Leeds, Leeds, UK
| | | | | | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Hulme
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Philip Stanley
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Kate McLintock
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Maureen Twiddy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Wilkes S, Burden‐Teh E, Robertson F, Grindlay D, Selby N. Skin and soft tissue infections and acute kidney injury: a systematic review. Br J Dermatol 2016; 175:182-4. [DOI: 10.1111/bjd.14368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- S.R. Wilkes
- Centre of Evidence‐Based Dermatology School of Medicine University of Nottingham Nottingham U.K
| | - E. Burden‐Teh
- Centre of Evidence‐Based Dermatology School of Medicine University of Nottingham Nottingham U.K
| | - F. Robertson
- Division of Medical Sciences and Graduate Entry Medicine University of Nottingham Nottingham U.K
| | - D. Grindlay
- Centre of Evidence‐Based Dermatology School of Medicine University of Nottingham Nottingham U.K
| | - N.M. Selby
- Division of Medical Sciences and Graduate Entry Medicine University of Nottingham Nottingham U.K
- Department of Renal Medicine Royal Derby Hospital Derby U.K
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Bryant PA, Hopper SM. Alternatives to ward admission from the emergency department. J Paediatr Child Health 2016; 52:237-40. [PMID: 27062630 DOI: 10.1111/jpc.13100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 11/26/2015] [Accepted: 12/03/2015] [Indexed: 11/28/2022]
Abstract
There is ever-increasing pressure on hospital resources in general and emergency departments (ED) in particular. At the same time, there is increasing recognition that traditional inpatient ward-based care is not necessary for the majority of children presenting to the ED with acute illness, and that there are patient, family and hospital benefits to pursuing other options. Here, we describe alternative pathways for children presenting to the ED, including short stay and observational medicine, hospital-in-the-home and non-admission enhanced care, in other words, additional management practices or pathways for children who are discharged from the ED. We discuss the principles, models and practical considerations involved in each of these.
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Affiliation(s)
- Penelope A Bryant
- Departments of General Medicine and, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,RCH@Home, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute.,Department of Paediatrics, University of Melbourne, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Sandy M Hopper
- Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute
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Al Alawi S, Abdulkarim S, Elhennawy H, Al-Mansoor A, Al Ansari A. Outpatient parenteral antimicrobial therapy with ceftriaxone for acute tonsillopharyngitis: efficacy, patient satisfaction, cost effectiveness, and safety. Infect Drug Resist 2015; 8:279-85. [PMID: 26300650 PMCID: PMC4536842 DOI: 10.2147/idr.s86341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Outpatient parenteral antimicrobial therapy (OPAT) is the administration of intravenous antimicrobial therapy to patients in an outpatient setting. It may be used for patients who have infections that require parenteral treatment but who are otherwise stable enough to not require admission as inpatients. OBJECTIVE We aimed to review the treatment of patients with acute tonsillopharyngitis at the OPAT health care clinic in the Bahrain Defense Force Royal Medical Services (BDF-RMS), with regard to efficacy, patient satisfaction, cost effectiveness, and safety. METHODS A retrospective case notes review was conducted for all patients admitted to the OPAT clinic in the BDF-RMS with acute tonsillopharyngitis treated with ceftriaxone, between March 2012 and March 2014. RESULTS In the period between March 2012 and March 2014, 97 patients with acute tonsillopharyngitis were treated with ceftriaxone for a minimum of 3 days at the OPAT clinic. In total, 94.8% of patients completed the prescribed course of ceftriaxone. Total cure was achieved in 89.7% of patients. Usage of the OPAT clinic led to cost savings of 10,693 BD, while total bed days saved were 301 over the 2-year period examined by this study. Participants in the program expressed high satisfaction rates, and the average (± standard deviation) score on a patient satisfaction survey was 4.41 (± 0.31) out of a total of 5. This study highlights the efficacy, patient satisfaction, cost effectiveness, and safety of the OPAT clinic service for the treatment of acute tonsillopharyngitis with ceftriaxone. We found a 45.5% drop in admission rate for acute tonsillopharyngitis after starting the OPAT service clinic and that 301 bed days were saved through this treatment. CONCLUSION This study showed that the management of acute tonsillopharyngitis with ceftriaxone in the OPAT clinic is safe, clinically effective, and cost effective, with low rates of complications/readmissions and high levels of patient satisfaction.
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Affiliation(s)
- Samah Al Alawi
- Department of Family Medicine, Riffa, Kingdom of Bahrain
| | | | | | - Anwar Al-Mansoor
- Department of Dietetics and Nutrition, Riffa, Kingdom of Bahrain
| | - Ahmed Al Ansari
- Training and Education Department, Bahrain Defence Force Hospital, Riffa, Kingdom of Bahrain
- Arabian Gulf University, Manama, Kingdom of Bahrain
- Royal College of Surgeons of Ireland, Busaiteen, Kingdom of Bahrain
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Hase R, Hosokawa N. Patterns of outpatient ceftriaxone use in a Japanese general hospital: an increased need for development of outpatient parenteral antimicrobial therapy programs. Infect Dis (Lond) 2015; 47:668-71. [DOI: 10.3109/23744235.2015.1031174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Uy N, Thiagarajan P, Musher DM. Cephalosporin side chain idiosyncrasies: a case report of ceftriaxone-induced agranulocytosis and review of literature. Open Forum Infect Dis 2015; 2:ofv007. [PMID: 26034758 PMCID: PMC4438888 DOI: 10.1093/ofid/ofv007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/14/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - Daniel M Musher
- Baylor College of Medicine ; Infectious Diseases Section , Michael E. DeBakey Veterans Affairs Medical Center , Houston, Texas
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Gilchrist M, Seaton RA. Outpatient parenteral antimicrobial therapy and antimicrobial stewardship: challenges and checklists. J Antimicrob Chemother 2014; 70:965-70. [PMID: 25538169 DOI: 10.1093/jac/dku517] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) has become, for many countries, an established form of healthcare delivery. At the same time, there have been calls to ensure the prudent use of the existing antimicrobial armamentarium. For OPAT, this presents a dilemma. On one hand, stewardship principles look for the most effective agent with minimal collateral effects. In OPAT, whilst the aims of the service are similar, convenience of dosing to optimize early hospital discharge or admission avoidance may take precedence over an agent's spectrum of activity. This brief article aims to highlight the importance and explore the challenges of antimicrobial stewardship in the context of OPAT. Within the UK, the safe and effective use of antimicrobials is modelled around the IDSA/Society for Healthcare Epidemiology of America stewardship practice guidelines with local customization where appropriate. Current UK stewardship practice principles were compared with published good practice recommendations for OPAT to identify how OPAT could support the broader antimicrobial stewardship agenda. It is essential that antimicrobial stewardship teams should understand the challenges faced in the non-inpatient setting and the potential benefits/lower risks associated with avoided admission or shortened hospital stay in this population. Within its limitations, OPAT should practise stewardship principles, including optimization of intravenous to oral switch and the reporting of outcomes, healthcare-associated infections and re-admission rates. OPAT should report to the antimicrobial stewardship team. Ideally the OPAT team should be formally represented within the stewardship framework. A checklist has been proposed to aid OPAT services in ensuring they meet their stewardship agenda.
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Affiliation(s)
- M Gilchrist
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - R A Seaton
- NHS Greater Glasgow and Clyde, Brownlee Centre, Gartnavel General Hospital, Glasgow G12 0YN, UK
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Abstract
Fifteen years ago, only a small minority of hospital inpatients were considered suitable for outpatient parenteral antimicrobial therapy (OPAT) services (Wiselka and Nicholson, 1997). Now, almost 70% of those treated with intravenous (IV) antibiotics as hospital inpatients are considered suitable (Hitchcock et al, 2009). Around 38-53% of those requiring OPAT are able to self-administer (Hills et al, 2012). The demand for IV antimicrobial therapy is increasing and the way it is being delivered is changing. The delivery of IV anti-microbial therapy in the community has the potential to make a huge difference to the way health care is delivered. It can enable people who would once have been admitted to hospital to be treated in the community. It can facilitate early hospital discharge (Nazarko, 2013a). Potentially, there are huge benefits in developing OPAT but there are also risks. People may be subjected to an invasive treatment when it is not necessary; therapy may be continued when it is no longer necessary (Nazarko, 2013b; Conant et al, 2014); and patients may be selected for OPAT who would be best treated in hospital. The key to providing safe and effective care is to work together to maximise benefits and minimise risk (Duncan et al, 2013). This article examines how acute and community services can work together to ensure appropriate selection, treatment and follow-up of patients.
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Coiffier G, Albert JD. Is ceftriaxone 2g once daily a valid treatment option for osteoarticular infections due to Staphylococcus spp., Streptococcus spp., and Gram-negative rods? Joint Bone Spine 2014; 81:200-2. [DOI: 10.1016/j.jbspin.2014.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2014] [Indexed: 12/01/2022]
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Outpatient parenteral antimicrobial therapy. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2014; 24:9-11. [PMID: 24421785 DOI: 10.1155/2013/205910] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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MacKenzie M, Rae N, Nathwani D. Outcomes from global adult outpatient parenteral antimicrobial therapy programmes: A review of the last decade. Int J Antimicrob Agents 2014; 43:7-16. [DOI: 10.1016/j.ijantimicag.2013.09.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 09/21/2013] [Indexed: 12/16/2022]
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Fabrication of an electrochemical sensor based on the electrodeposition of Pt nanoparticles on multiwalled carbon nanotubes film for voltammetric determination of ceftriaxone in the presence of lidocaine, assisted by factorial-based response-surface methodology. J Solid State Electrochem 2013. [DOI: 10.1007/s10008-013-2243-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Fifteen years ago, only a small minority of hospital inpatients were considered suitable for outpatient parenteral antimicrobial therapy (OPAT) services (Wiselka and Nicholson, 1997). Now almost 70% of those treated with intravenous antibiotics as hospital inpatients are considered suitable (Hitchcock et al, 2009). In total, 38-53% percent of those requiring OPAT are able to self-administer (Hills et al, 2012). The demand for intravenous antimicrobial therapy is increasing and the way it is being delivered is changing. This article examines service models, setting up services and developing staff to enable them to deliver OPAT services.
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