Features of selected antimicrobials used for outpatient parenteral antibiotic therapy

CBC: complete blood cell count; BMP: basic metabolic profile; K: potassium; Cr: creatinine; BUN: blood urea nitrogen; ALT: alanine transaminase; AST: aspartate transaminase; ALK: alkaline phosphatase; Tbil: total bilirubin; ADR: adverse drug reaction; NA: not applicable/no oral formulation; Grav: gravity; Elas: elastomeric; EID: electronic infusion device; IVP: intravenous push; po: by mouth; CK: creatine kinase; ULN: upper limit of normal; IV: intravenous; QTc: corrected QT-interval; LFT: liver function tests.
* Bioavailability: changing to oral medications when possible is part of good antimicrobial stewardship. Clinicians should consider the full clinical situation, including the appropriateness of oral antimicrobials for the condition being treated. Potential for interaction with foods and other medications as well as concomitant illnesses and the potential for impaired gut absorption must also be considered.
¶ Doses per day: assumes normal renal and hepatic function. More than 2 to 3 doses per day may be impractical for pediatric outpatient parenteral antimicrobial therapy (OPAT) that requires adult infusion assistance for every dose. Dosing more frequently than once daily is typically not practical for patients who receive care in infusion centers.
Δ Devices: very limited published information on the use of these devices in OPAT. Individual infusion pharmacies have variable policies and device availability. Not all drugs are compatible with all delivery options. EIDs can be programmed to automatically deliver multiple doses per day but they require that the patient be connected to a small device virtually continuously and are not covered by all insurance carriers. Elas are very simple to use but also are not covered by all insurance carriers. Gravity delivery (infusion without a pump, using a roller clamp) is less expensive but also less convenient due to longer infusion times and complexity for patients to learn. Depending upon care setting, use of a traditional infusion pump may be selected in lieu of gravity for rate control. IVP is very convenient because of rapid infusion time.
◊ These are recommendations based on frequency and seriousness of reported adverse events. The monitoring plan for an individual patient may be different based on the comorbid conditions and anticipated duration of OPAT. For instance, for shorter courses of linezolid, ceftriaxone, or clindamycin, it may not be necessary to monitor LFTs and/or renal function. Alternatively, for longer courses of fluoroquinolones, weekly lab monitoring may be appropriate. For patients with normal baseline labs, less intense monitoring may be appropriate.
§ Risk of Torsades de Pointes (TdP): known, known to prolong QTc interval and cause TdP even when taken as recommended; possible, can cause QTc prolongation but not known to cause TdP when taken as recommended; conditional, associated with TdP but only under certain conditions (ie, excessive dose, with hypokalemia, with other interacting drugs) or by creating conditions that induce TdP (inhibiting metabolism of QTc prolonging drugs); special, high risk of TdP in patients with congenital long QT syndromes due to other actions. Source for TdP risk^[1].
¥ Aminoglycoside monitoring: monitor concentrations minimum weekly. Goal aminoglycoside trough values differ according to the drug, infection, and dosing strategy.
‡ For medications with limited stability, home delivery more frequently than once weekly will be required. Some drugs may be reconstituted in the home using a use-activated container, if available.