Executive Summary

These guidelines were formulated to assist physicians and other health care professionals with various aspects of the administration of outpatient parenteral antimicrobial therapy (OPAT). Although there are many reassuring retrospective studies on the efficacy and safety of OPAT, few prospective studies have been conducted to compare the risks and outcomes for patients who receive treatment as outpatients rather than as inpatients. Because truly evidence-based studies are lacking, the present guidelines are formulated from the collective experience of the committee members and advisors from related organizations.

Important aspects of OPAT are described in the text and tables and include the following:

The literature supports the effectiveness of OPAT for a wide variety of infections (table 1 and the Appendix).

Table 1.

Infections treated with outpatient parenteral antimicrobial therapy (OPAT) and the antibiotics used in 4 studies or sites.

Table 1.

Infections treated with outpatient parenteral antimicrobial therapy (OPAT) and the antibiotics used in 4 studies or sites.

A thorough assessment of the patient's general medical condition, the infectious process, and the home situation is necessary before starting therapy (table 2)

Table 2.

Specific considerations in evaluating patients for outpatient parenteral antimicrobial therapy (OPAT).

Table 2.

Specific considerations in evaluating patients for outpatient parenteral antimicrobial therapy (OPAT).

Prescribing physicians should be aware of a number of aspects of OPAT which distinguish it from other forms of therapy. These include the required teamwork, communication, monitoring, and outcome measurements (tables 3 and 4).

Table 3.

Key elements required for an outpatient parenteral antimicrobial therapy (OPAT) program.

Table 3.

Key elements required for an outpatient parenteral antimicrobial therapy (OPAT) program.

Table 4.

Key elements required for evaluating an outpatient parenteral antimicrobial therapy (OPAT) program when the patient is to be referred.

Table 4.

Key elements required for evaluating an outpatient parenteral antimicrobial therapy (OPAT) program when the patient is to be referred.

The physician has a unique role on the OPAT team, which may also include nursing, pharmacy, and social services. These responsibilities include establishing a diagnosis, prescribing treatment, determining the appropriate site of care, monitoring during therapy, and assuring the overall quality of care.

Antimicrobial selection for OPAT is different from that for therapy in the hospital. Once-daily drug administration has many advantages. Potential for adverse effects and the stability of an antimicrobial once it is mixed must be considered (tables 5–7).

Table 5.

Properties of commonly prescribed antimicrobials at various temperatures.

Table 5.

Properties of commonly prescribed antimicrobials at various temperatures.

Table 7.

Suggestions for laboratory parameters that should be monitored weekly during outpatient parenteral antimicrobial therapy (OPAT).

Table 7.

Suggestions for laboratory parameters that should be monitored weekly during outpatient parenteral antimicrobial therapy (OPAT).

The importance of administering the first dose of an antibiotic in a supervised setting is emphasized.

Regular clinical and laboratory monitoring of patients receiving OPAT is essential and varies with the antimicrobial chosen (table 8).

Table 8.

Outcome measures for outpatient parenteral antimicrobial therapy (OPAT).

Table 8.

Outcome measures for outpatient parenteral antimicrobial therapy (OPAT).

Outcomes measures should be an integral part of any OPAT program, to assure the effectiveness and quality of care (table 9).

Table 9.

Internet resources with information on outpatient parenteral antimicrobial therapy (OPAT).

Table 9.

Internet resources with information on outpatient parenteral antimicrobial therapy (OPAT).

Children receiving OPAT must be considered differently because of their special needs.

Introduction

The practice of administering intravenous antimicrobial therapy in the home and in alternate care settings has grown rapidly since it was first described in 1974 by Rucker and Harrison [1]. The most common infections treated and antimicrobials used by a variety of programs are shown in table 1. In the United States, OPAT is estimated to be a multibillion-dollar-a-year industry and is provided to 1 in 1000 Americans each year [10]. The growth of OPAT has been fueled by a variety of factors including the push for cost containment, the development of antimicrobial agents that can be administered once daily, technological advances in vascular access and infusion devices, increased acceptance of such therapy by both patients and health care personnel, and the availability of reliable and skilled services for OPAT in the community. Although OPAT has become widely accepted as a form of medical therapy (see Appendix), more information is needed regarding its benefits, safety, and limitations. This is especially true with the economic incentives for early discharge that exist for payors.

These guidelines update those written in 1997 [11] and are intended to ensure successful implementation of parenteral antimicrobial services for patients in varied community settings, including the home and outpatient facilities, such as physicians' offices, hospital clinics, ambulatory-care centers, day hospitals, and skilled nursing facilities. They have been formulated to incorporate the perspectives of the team of physicians, nurses, pharmacists and other health care professionals necessary for an effective and safe program [6, 8, 12]. Advice and participation were requested of the leading infusion-nurse, pharmacy, infection control, internal medicine, pediatric medicine, and home-care societies to gain a broad perspective on the multidisciplinary approach needed.

The recommendations were formulated from the collective clinical experience of the Infectious Diseases Society of America Guidelines Committee and representatives from the invited organizations. In the majority of cases, the strength and quality of evidence in support of OPAT is limited by a lack of prospective studies and a large number of confounding variables, therefore no ratings are given here. The information herein, however, can provide a guide for programs to develop the best practices possible in their environment.

These guidelines are general and need to be adapted to many variables in each treatment setting. Because of the focus on OPAT, the related topics of duration of therapy, when to switch to oral anti-infective therapy, and infusion therapies other than antimicrobials are not addressed.

Basic Definitions

In these guidelines, the acronym “OPAT” is used in place of “CoPAT” (community-based parenteral anti-infective therapy), because “OPAT” is the more commonly used term. “OPAT” is generally used to refer to the provision of parenteral antimicrobial therapy in at least 2 doses on different days without intervening hospitalization. The term “outpatient” is used to refer to the varied settings in which intravenous antimicrobial therapy can be provided without an overnight stay in a hospital. These include the home, physician's offices, hospital-based ambulatory-care clinics, emergency departments, hemodialysis units, freestanding infusion centers, skilled nursing or long-term care facilities, and rehabilitation centers. The term “parenteral” encompasses intravenous, subcutaneous, and intramuscular routes of administration. “Antimicrobial” refers to antiviral, antifungal, and antibacterial medications. “Caregiver” refers to any family member, friend, or paid nonprofessional individual with the ability and willingness to administer treatment and to observe and report significant events.

Patient Evaluation and Selection

Initiation of OPAT requires that a physician determine that such therapy is needed to treat a defined infection, that hospitalization is not needed to control the infection, and that alternate routes of drug delivery are not feasible or appropriate. Factors to consider in patient evaluation and selection are outlined in table 2.

The primary goals of outpatient therapy programs are to allow patients to complete treatment safely and effectively in the comfort of their home or another outpatient site and to avoid the inconveniences, complications, and expense of hospitalization. However, OPAT is not appropriate if the patient's medical care needs would be better met in the hospital. Financial concerns in selection of patients for OPAT should not take precedence over the patient's welfare.

There is potential for both overuse and underuse of OPAT. A careful analysis of patients referred for home therapy will demonstrate that a subset of referrals may be inappropriate [6]. Some patients require hospitalization for ongoing care; for others, oral therapy is appropriate, and, for some, antimicrobial therapy may not be needed. Because of the risks of progressive infections and for adverse events, physicians with training in the specialty of infectious diseases or with experience and knowledge of OPAT should be involved in the evaluation of candidates for therapy.

Medical assessment. Determination of the status of the patient's infection and any underlying medical condition is a critical component of the assessment process. The increasing use of OPAT without initial hospitalization makes the challenge of medical assessment even more important. The patient's risk of sudden or life-threatening changes in health should be low. OPAT may be appropriate for patients with terminal conditions, if the therapy contributes to their quality of life and comfort. Often the patient's participation is more dependent on medical and psychosocial factors other than the type of infection present. Table 1 lists the more common infections and antimicrobials used at several different OPAT centers. For most programs, soft-tissue and bone infections are the most common diagnoses.

Patients with a sepsis syndrome or infections such as meningitis, endocarditis, septic arthritis, or severe pneumonia should usually be hospitalized for initiation of parenteral antimicrobial therapy because of the risk that the patient's medical condition may suddenly worsen or that hospital-based procedures may be needed. Once their condition has stabilized, however, many of these patients may be appropriately discharged to receive OPAT.

Recent guidelines for community-acquired pneumonia indicate that OPAT may be useful for selected patients [13–16]. Studies by Fine and coworkers [17, 18] suggest OPAT can be much more widely used for pneumonia, if community resources are available and physicians are aware of them. Selected patients with endocarditis are also candidates for OPAT [19]. There is a significant experience in treating nonenterococcal endocarditis on an outpatient basis, usually with once-daily ceftriaxone and sometimes without hospitalization [20–22]. However, patients with endocarditis who have prosthetic valves, persistently positive blood culture results, poorly controlled congestive heart failure, large vegetations (>10 mm in length), recurrent embolic events, Staphylococcus aureus etiology, or conduction abnormalities are at increased risk for complications that may be more quickly recognized and treated in the hospital. A conservative approach suggests inpatient care or daily outpatient follow-up during the first 2 weeks of therapy because of the increased risk of life-threatening events, such as acute congestive heart failure, embolus, or myocardial abscess [19]. Andrews and von Reyn [23] suggest that patients with uncomplicated endocarditis due to viridans group streptococci could be discharged to receive OPAT after 1 week of hospitalization.

Injection drug use or alcohol abuse problems should be specifically evaluated before therapy is initiated. Patients who are likely to abuse a vascular access system are poor candidates for OPAT [24]. A skilled nursing facility may be the most appropriate model for care. Intramuscular injections or daily infusions with removal of the catheter may be appropriate for some patients [25]. Some computerized infusion pumps can monitor therapy and may reduce the likelihood of tampering. The patient's ability to adhere to the prescribed regimen and the threat of unauthorized vascular access will determine whether therapy outside of the hospital setting is advisable and whether a long-lasting venous line is appropriate.

Patient and caregiver ability assessment. The capabilities of patients who will receive OPAT and of their caregivers must be carefully evaluated before they are accepted into the program. Patients or their caregivers must be able to assume responsibility for the infusion, the care of the vascular access device (VAD), and the care of the catheter infusion site, and be able to recognize and report new problems, such as rash, diarrhea, or fever. Home care of children requires the involvement of parents or guardians and requires standards the same as, if not higher than, those for adults. Daily treatment in a physician's office or infusion center is an option for selected patients with unstable diseases or inadequate housing or because of personal preference or insurance restrictions. Patients receiving OPAT should have their VAD and health status assessed by a licensed health-care practitioner. Participation in OPAT by selected patients with physical limitations may be facilitated through the use of electronic and mechanical infusion devices [26].

Patients should be informed of the economic and the medical aspects of OPAT before the initiation of therapy. Patients should be counseled regarding insurance coverage and anticipated out-of-pocket costs to allow an informed decision before OPAT begins. Documentation of informed consent with written information may be appropriate.

Ongoing communication among patient, caregiver, nurse, pharmacist, and physician is critical to the success of OPAT. Patients must have means of immediate communication (telephone or cellular telephone) and transportation for physician appointments and emergency services. Communications should be undertaken in such a way that patient confidentiality is preserved. Telemedicine with home monitors or interactive audio/video devices for home assessment and compliance may be helpful [27, 28].

Home assessment. The health care team must also have knowledge of the patient's home environment prior to initiation of OPAT. This information is ideally obtained by a visit to the home before or at the time of initiation of therapy, but verbal assessment may suffice [29]. Potential problems, such as the funtioning of utilities, safety issues, cleanliness, substance abuse, access to transportation, and social strife need to be assessed. Home visits may also pose a risk to health-care practitioners, which should be considered.

Key Elements of an Opat Program

Physician-directed OPAT program. The key elements of physician-directed OPAT programs are outlined in table 3. Although any physician can legally order OPAT, not all physicians are expert in doing so. The responsible physician should be knowledgeable about infectious diseases and OPAT so that poor clinical responses or problems such as therapeutic failure, adverse events, drug toxicity, and infusion device and vascular access issues are avoided or appropriately and promptly addressed. In some clinical settings, an infectious diseases consultation is required before a patient can be sent home to receive OPAT [6, 30]. Some organizations have focused on accreditation requirements to establish minimum standards for physician supervision and management of home care agencies [31]. Although there has been enormous growth in home care services nationwide, direct physician involvement has not kept pace, largely because of low levels of reimbursement for management or direct patient care in the home setting [32, 33].

Infusion nurse specialists and pharmacists should also be knowledgeable and experienced with OPAT, as should other members of the health care team, which may include social workers, physical therapists, dietitians, and occupational therapists. The American Society of Health System Pharmacists has developed specific guidelines on the pharmacist's role in home care [34, 35].

OPAT programs must have systems for rapid communication between nurses, pharmacists, physicians, and patients. Such systems are required both for initial treatment planning and for monitoring of ongoing care. Communication via pagers, cellular telephones, facsimile machines, and electronic mail has become increasingly important, although it must comply with the Health Insurance Portability and Accountability Act (HIPAA). Programs should have written policies and procedures that outline the responsibilities of the team members and address issues such as patient selection criteria, drug preparation, vascular access, laboratory monitoring, and disposal of waste and needles. Patient and caregiver education materials should provide specific information about the program, a list of emergency-access telephone numbers, a statement regarding precautions and risks of OPAT, and when possible, specific information about the disease process and the antimicrobials used. Plans for quality assurance and outcomes monitoring should also be incorporated into OPAT programs. Policies and procedures may be developed for an individual program or developed with one of several commercial sources.

Referral to OPAT programs. The key elements for OPAT programs to which a patient is referred are listed in table 4. These relate to criteria for programs that the prescribing physician does not control even though the physician is ultimately responsible for the patient's care and outcome. Specific administrative elements, in addition to those listed in table 3, should be in place. Because prescribing physicians remain responsible for clinical care decisions, it is important for them to assess the quality of care provided by the OPAT delivery organization and to document deficiencies. Physicians are considered legally responsible for deciding whether a patient should be treated as an outpatient and to assure the quality of care during OPAT [36]. In addition, consultants should clarify their postdischarge role with other doctors involved in the patient's care [37].

An experienced physician director or advisor for an OPAT delivery organization is important for the success of the program. This position is analogous to that of the medical director for hospice programs. Such persons provide clinical input into policies and procedures and oversee quality-of-care activities.

A home-infusion company should have written policies available regarding the qualifications of their staff, the procedures used, and the quality assurance systems in place. The company should be willing to share this information as well as the charge estimates for the proposed course of therapy. Patient education materials are an important resource, which can be helpful for conveying information about safety, responsibilities, and compliance and general advice.

The choice of a model for administering OPAT varies with individual patient needs, the program resources available, and the payor. It is possible to change the type of delivery model depending on the anti-infective agent used, the patient's capability for self-care, and the need for other medical services. The delivery models can be roughly classified according to whether the antimicrobial is administered in an infusion center, at a skilled nursing facility, or at home by a nurse or is self-administered [11, 38].

In the self-administration model, antimicrobials are infused by the patient, a family member, or another responsible person. Infusions may occur in the home, at work, or any other site. Methods by which therapy can be self-administered include gravity infusion systems and a variety of administration systems that can be adapted to the needs of the patient, the VAD, and the drug used. This model has the advantages that it provides autonomy for the patient and reduces expense.

If a visiting nurse—service provider has staff that is experienced in home infusion, medications may be infused in the home under the direct supervision of a nurse. Antimicrobials may be administered by gravity infusion, by pump, or by intravenous pressure infusion ("IV push") [39]. The number of nursing visits authorized by third-party payors, the availability of infusion nurses, and other considerations may limit the applicability of this model.

The infusion-center model has been established in many locations, including physician offices, outpatient centers, hospital outpatient clinics, and, less frequently, an emergency department or extended care facility. These centers offer the advantage of ready access to medical equipment and personnel but require the patient to travel to the facility for treatment.

Skilled nursing facilities may provide parenteral antimicrobial therapy and have replaced prolonged hospitalization in situations where patients are not capable of self-care, do not have satisfactory caregivers, have multiple medical problems, are undergoing rehabilitation, do not have insurance coverage for home therapy, or are not likely to be compliant. Subacute care facilities and rehabilitation centers offer additional options for patients who require skilled therapy beyond infusion of antimicrobial agents.

Roles of the Team Members in Opat

An effective OPAT program requires an interdisciplinary team of professionals committed to high-quality patient care [6, 11, 12, 40–43]. The typical OPAT team consists of the patient, a physician, an infusion nurse, and, often, a pharmacist. In many situations, a case manager for the hospital or third-party payor will play a vital role. Social workers are often involved in the selection of patients and coordination of therapy. Family members or other caregivers should participate in the planning and delivery of therapies outside of the hospital. There are inevitably areas of overlapping responsibilities, such as selection of intravenous access devices, determination of the most appropriate site of care, and monitoring of laboratory results. Several physicians (the primary physician, an infectious disease consultant, and other specialists) may be involved in follow-up, which adds to the challenges in coordinating care. For OPAT to be effective, not only optimal patient selection and education but also communication and coordination of care are essential. Reports of laboratory values, discussions of patient assessments, trouble-shooting, and changes in orders are often handled by telephone, electronic mail, or facsimile. Continual availability of most members of the care team is critical to the success and safety of OPAT.

Expertise and experience in the management of antimicrobial therapy and VADs are required to optimize outcomes and minimize risk in OPAT programs. Because no specific OPAT certification is currently available for physicians, nurses, or pharmacists, OPAT expertise may be assessed by a combination of elements.

The physician. The role of the physician in OPAT has several unique aspects, and includes establishment of a diagnosis, determination of whether OPAT is appropriate, selection of antimicrobials, ordering of monitoring tests, and assessment at follow-up visits [6, 11,12, 42, 43]. The physician, the infusion nurse specialist, and the patient should determine the appropriate type of vascular access. In consultation with other members of the team, the physician selects the site of care. The physician is responsible for the ongoing assessment of the patient's clinical response to therapy, monitoring for drug toxicity, management of vascular access problems, care of concurrent medical problems, and coordination of the efforts of other members of the team. The OPAT physician should approve any changes in treatment orders, including changes in doses or intervals for administration of antimicrobial agents. Collaboration between the primary physician and physician managing OPAT is imperative to avoid the possibility that potential problems will be overlooked or that efforts will be duplicated.

The issue of physician certification or credentialing to provide OPAT is evolving. The American Academy of Home Care Physicians offers a certifying examination in home care; however, measurements of competence specific to the provision of OPAT are only a small portion of the examination. The Residency Review Committee of the American Board of Internal Medicine, in its standards for training programs in infectious diseases, lists “appropriate use and management of antimicrobial agents in a variety of clinical settings, including the hospital, ambulatory practice and the home” as a curriculum component [44].

The infusion nurse. The role of the infusion nurse varies with the OPAT model and the site of care [26, 45, 46]. At the time of initial patient assessment, nurses provide valuable input as to the patient's suitability for parenteral therapy outside of the hospital. They usually assume the lead role in recommendations for the type of VAD to be selected and in the care of the infusion device. Patient education, training, and monitoring fall within the realm of responsibility of the infusion nurse as well. When patients receive OPAT at home, nurses can provide a valuable home assessment. They may infuse the antimicrobial agent or provide oversight to others providing care. They may also serve bridging functions for the team and play a pivotal role in coordination of care. Nurses may achieve specialty certification in infusion therapy through the Infusion Nurses Certification Corporation (INCC), the sister organization of the Infusion Nurses Society, which has established standards for nurses in all care settings [26].

The pharmacist. The pharmacist on the team is usually responsible for the acquisition, storage, compounding, dispensing, and delivery of the antimicrobials, as well as for monitoring for adverse events and potential drug interactions [34, 43, 47]. The American Society of Health-System Pharmacists (ASHP) suggests that pharmacists conduct a preadmission assessment and that they educate patients about the antimicrobial agent and possible side effects [34]. The ASHP Section of Home, Ambulatory and Chronic care has published guidelines for pharmacists practicing in this setting [35].

The patient and the caregiver. The roles of the patient and caregiver in OPAT must not be underestimated; they both should play a part in planning the OPAT program and follow-up [29, 42]. Education about the infection, complications, treatment plans, potential problems, communication, and expected outcome is necessary. Their responsibilities of the patient and the caregiver are far greater than for hospitalized patients, and their adherence to therapy is essential. Patients and caregivers are often pleased to be involved in their own care and often come away with a sense of pride and satisfaction in their role.

The safety of the medical staff should also be considered, especially with home visits after dark and in high-crime neighborhoods. Concerns bearing on US Occupational Safety and Health Administration regulations with regard to worker safety and needlesticks should be as great, if not greater, with outpatient care than with inpatient care [48]. Bloodborne pathogens remain a problem and exposure remains a risk, although the risks are less than in a hospital [49]. Use of needleless administration systems is recommended.

Antimicrobial Selection and Administration

When selecting an antimicrobial for OPAT, multiple factors must be taken into account, including the probable infecting organism, the pharmacodynamic and pharmacokinetic properties of candidate drugs, and drug stability. The antimicrobials frequently used for OPAT are listed in table 1. Although almost any antimicrobial can be used, drugs with long half-lives continue to be extensively prescribed, although specific choices will vary with the patient population, the likely diagnosis, the anticipated duration of therapy, and physician preference. Use of agents that can be administered once daily reduces disruption of daily activities and limits the potential for complications. The choice of antimicrobials for OPAT needs to be continually evaluated as new oral agents may replace some parenterally administered choices, and antimicrobial resistance is an ongoing issue.

The initial dose of an intravenous agent should be administered in a supervised setting, such as a physician's office, ambulatory care department, or the hospital, before a patient's discharge to home care. Personnel trained in resuscitation and appropriate equipment should be readily available.

For patients with pneumonia, there is evidence that prompt administration of an intravenous antimicrobial may improve outcomes with respect to 30-day mortality [50] and lessen the length of hospital stay [51]. Administration of a parenteral antibiotic in the physician's office before hospitalization may also improve outcomes [52].

Table 5 displays the parameters of antimicrobials that are used for OPAT. The half-life of a drug determines the frequency with which it can be administered. The likelihood that phlebitis will develop influences the decision about the type of VAD needed. Drug-stability information is important for determining how often a drug must be mixed and how long it can be stored. The rate of administration must also be monitored closely, especially with vancomycin, amphotericin B, acyclovir, ganciclovir, and foscarnet. Although IV push administration has been advocated for some of the β-lactam antibiotics, it has not been well studied and may cause minor symptoms [53–56]. The pH, osmolality, and irritative qualities of a drug need to be considered with this type of rapid intravenous administration.

Research regarding pharmacokinetics and pharmacodynamic factors has influenced the dosing of antimicrobial agents [11]. Aminoglycosides, which show concentration-dependent killing and a prolonged postantibiotic effect (i.e., a prolonged effect on bacterial growth after antibiotic therapy ceases), may be given in a once-daily dose. Such a regimen may offer therapeutic advantages and may also reduce the incidence of nephrotoxicity and ototoxicity [57–59]. However, the use of once-daily aminoglycoside therapy by pregnant women, children, elderly persons, and critically ill patients has not been fully evaluated. Once-daily dosing recommendations for patients with renal dysfunction, neutropenia, burns, liver disease, or endocarditis should be used with caution [57].

The β-lactam antimicrobials, because of their short half-lives and time-dependent killing with only a brief postantibiotic effect, might best be given by continuous infusion [60, 61]. However, β-lactams, such as ampicillin, that have short half-lives and that are unstable at body temperature may need to be mixed daily and administered as frequently as every 4 h, depending on renal function.

Ceftriaxone and ertapenem have sufficiently long half-lives to provide serum concentrations above the MICs for most susceptible organisms for 12–24 h and thus can be given once daily. Vancomycin has been used extensively in outpatient settings because of its attractive dosing characteristics and the increasing prevalence of infections due to oxacillin-resistant S. aureus. It is usually given every 12 h, but less frequent administration is indicated for patients with renal dysfunction and for elderly patients [62]. The increasing concern regarding vancomycin-resistant enterococci and the emergence of vancomycin-resistant S. aureus has necessitated limiting the use of vancomycin to clear indications [63, 64].

Although many drugs are stable both at room temperature and when refrigerated, the stabilities of ampicillin, quinupristine-dalfopristin, lipid formulations of amphotericin B, imipenem-cilastatin, and trimethoprim-sulfamethoxazole in solution are of concern. These drugs are stable in solution at room temperature for <8 h, so they should not be administered by continuous infusion therapy. Body temperatures likely result in even more rapid drug deterioration. An alternative to premixed antibiotics is to mix them with a prepackaged system just before use. A number of drugs are not approved for pediatric use—for example, fluoroquinolone and quinupristin-dalfopristin.

Multiple factors need to be weighed when considering use of a VAD, and the type of infusion system chosen must be individualized [26, 65]. Issues to be considered include the patient's overall clinical status, age, and vein condition; the diagnosis; current vascular access; antimicrobials prescribed and their frequency of administration; need for a programmable infusion pump; and the anticipated duration of therapy [66].

Peripheral short catheters are appropriate for patients with good vein status who will receive a short course of therapy (generally <2 weeks for adults and <1 week for children) with an agent that has low potential for causing phlebitis or soft-tissue damage if infiltrated. Midline catheters (7.5–20 cm in length) are also available for patients with moderately difficult venous access or whose treatment is anticipated to last >1 week. A wide range of central VADs are available for longer durations of therapy and are usually placed when the use of a programmable ambulatory infusion pump is planned. Implantable ports are not commonly used for OPAT unless already in place.

The use of peripherally inserted central catheters (PICCs) has increased since the previous OPAT guidelines were published [67, 68]. These catheters are appropriate in many circumstances in which the need for prolonged (more than 1–2 weeks) vascular access is present and the risks of complications or expense of other types of central lines is not warranted. PICCs are also appropriate for use with programmable pumps. When a PICC is placed, the catheter length should be recorded and checked again when it is removed. A chest radiograph should be performed after PICC placement to confirm the position of the catheter tip, especially if irritative or vesicant agents are to be used [69–72].

Tunneled and nontunneled central catheters are also widely used for longer-term access and for the infusion of irritative agents. They may be preferred over PICCs in patients who are active or in infants and children from whom it is necessary to obtain blood samples frequently. For patients who require multilumen catheters, a tunneled catheter may be more appropriate, although double-lumen PICCs are available.

Monitoring Clinical and Laboratory Aspects

The clinical aspects of OPAT encompass a broad range of patient care issues. These include monitoring the patient for response to treatment and potential adverse events, in addition to care of the VAD. Obtaining blood samples at regular intervals (as appropriate for the drug administered) is required to monitor laboratory values during most courses of therapy. Table 6 displays the frequency of adverse effects serious enough to stop antimicrobial therapy, which differ according to the drug being administered [73].

Table 6.

Frequency of adverse effects due to intravenously administered antimicrobials used for outpatient parenteral antimicrobial therapy (OPAT).

Table 6.

Frequency of adverse effects due to intravenously administered antimicrobials used for outpatient parenteral antimicrobial therapy (OPAT).

Clinical monitoring. The frequency of patient follow-up visits with the supervising physician needs to be determined when a patient begins a course of OPAT. In most circumstances, patients see the managing physician once or twice each week. Some patients need to be seen daily by a physician, especially at the beginning of OPAT. Patients with endocarditis, meningitis, or other life-threatening infections may also require more frequent visits [23]. Less frequent visits may be appropriate for patients with stable chronic infections, few comorbid conditions, and appropriate caregiver support. Nurse and pharmacist assessments and monitoring should not substitute for face-to-face physician evaluations of patients. Visits to the referring or primary care doctor may also be helpful. If there are transportation difficulties, care may be coordinated with a local physician. Patients should also be seen after completion of OPAT to be sure they have responded to therapy are doing well and have had no adverse events.

The frequency of nursing visits will vary with the patient's condition, needs, and diagnosis. More frequent nursing visits may be needed at the outset of therapy for clinical monitoring and teaching purposes. A growing number of patients and their caregivers are being taught self-administration of antimicrobials, with a resulting decrease in the number of nursing visits.

Laboratory monitoring. The guidelines displayed in table 7 address the minimum frequency of monitoring for adverse reactions and toxicity. Additional studies may be needed for determination of the response to therapy.

Adverse effects in patients receiving antimicrobial therapy are not unusual [11, 73–76]. Table 6 displays information from the OPAT Outcomes Registry, which indicates that 3%–10% of antimicrobial courses are stopped prematurely because of an adverse reaction. If laboratory parameters show an adverse trend, the frequency of laboratory monitoring should be increased; in some cases, the medication may need to be changed or its use discontinued. Data suggest that some adverse reactions, such as renal or vestibular toxicity and leukopenia, become more frequent as the length of therapy increases [73]. Even though an infection is responding, the need for regular laboratory monitoring remains [77].

Patients receiving aminoglycoside therapy should have serum creatinine determinations twice weekly [11]. Weekly monitoring may be considered for infants and children if they are clinically stable. Patients receiving prolonged courses of aminoglycoside therapy should have an initial determination of the trough and peak serum concentration around the third or fourth dose and after any dosage change. Determination of trough or midpoint serum concentrations should be considered for those patients receiving aminoglycoside therapy as a single daily dose, to document serum concentrations [78, 79]. When aminoglycoside trough serum concentrations increase, more frequent determination of serum creatinine levels may be necessary [80]. Nomograms may be helpful [78, 79]. Serum drug and serum creatinine levels should be used to adjust aminoglycoside dosing, although aminoglycoside concentrations do not always correlate with the renal or vestibular toxicity [80–83].

When an aminoglycoside is used, patients and caregivers should be instructed to monitor otologic symptoms by clinical means, such as the volume of conversation, the development of tinnitus, vertigo, or a feeling of fullness in the ears [84]. Any changes noted should prompt consideration of an audiometric evaluation and/or discontinuation of aminoglycoside therapy. The patient's understanding of these instructions should be clearly documented in the medical record and consideration should be given to including the possibility of an adverse drug reaction in the written consent to receive OPAT that is obtained at the start of therapy. For infants and young children, audiometric screening should be considered for those scheduled to receive prolonged therapy (4–6 weeks). Symptoms of vestibular dysfunction should be reviewed during each visit with the physician and nurse. Physical examination may also be helpful. Formal vestibular testing is not practical in most settings. The “dynamic illegible E test” is an inexpensive method of screening for vestibular dysfunction that can be performed in the physician's office [85, 86].

Audiometry is no longer routinely recommended when aminoglycosides are administered to adults, as it has not been documented to be of value for either healthy individuals or hospitalized patients [87]. Infectious diseases practitioners do not routinely obtain audiograms during aminoglycoside therapy [88, 89].

The value of vancomycin serum concentration data is controversial in the published literature [90–92]. Toxicity does not appear to be related to serum levels of vancomycin [93–95], although it does increase when vancomycin is given with other ototoxic or nephrotoxic agents [96, 97]. A correlation between serum vancomycin levels and clinical outcomes has not been convincingly demonstrated in humans [92, 98, 99]. but there is some evidence of a relationship in an animal model [100]. There have been a number of attempts to develop formulae and nomograms for vancomycin dosing, with variable success [101–103]. Specific patient populations have been shown to have poorly predictable serum concentrations when dosages are based on standard parameters [104–115]. In addition, vancomycin clearance decreases and serum concentrations increase during the course of prolonged treatment [116].

Given the high incidence of adverse drug reactions and to assure effective levels, it is recommended that both trough and peak serum levels be determined, until further studies of these relationships are undertaken [96, 97]. There are also concerns that inadequate dosing of antimicrobials, including vancomycin, may promote the development of bacterial resistance [117].

Of particular note is the need to monitor for hepatic toxicity in patients receiving oxacillin, caspofungin, or quinupristin-dalfopristin therapy [118]. Leukopenia is a common adverse effect with penicillin or vancomycin therapy [119, 120].

VAD care. The care of the VAD will vary with the type of device. Dressing changes, frequency of flushes, and site maintenance are based upon specific protocols for the individual VAD. In 2002, the Centers for Disease Control and Prevention (CDC) published guidelines for the prevention of catheter-related infection [121–123]. The Infusion Nurses Society has also published practice standards for insertion, care, and maintenance [26]. Catheters need to be secured well, especially for infants and children, to avoid accidental or purposeful manipulation of the device.

Patients and caregivers should be instructed in the monitoring and care of the VAD and should inspect the device daily. A health care practitioner should examine short and midline catheters at least twice per week and central catheters at least weekly. The entrance site should be examined for evidence of local phlebitis, induration, erythema, tenderness, and leakage [122]. The development of ipsilateral edema of the neck or arm in association with a PICC or other central catheter should prompt evaluation for a deep venous thrombosis [53], which usually requires removal of the device [121, 124]. Peripheral catheters should be assessed for replacement every 72 h when used in adults, although, with close monitoring, a longer duration may be considered for patients receiving OPAT [122, 125].

Opat Outcomes and Patient Safety

The measurement of outcomes by an OPAT program is a part of the continuous performance improvement process through which health-care providers attempt to improve and assure the quality of their care and service. Parameters are chosen to assess the safety, efficacy, and cost of the OPAT program [1–9, 19–22, 74–78]. The best-studied OPAT outcomes indicators have been those related to cost savings and financial analyses [126]. Results of outcomes analyses may also be useful for marketing and contracting with payors. Accrediting bodies such as the Joint Commission for the Accreditation of Health Care Organizations (JCAHO) and the National Committee for Quality Assurance require outcomes measurements as a part of their certification process but do not specify the parameters or indicators to use. The JCAHO requires reporting and root cause analysis of “sentinel events” resulting in unexpected death or permanent injury arising from therapy [127, 128]. As the financial pressures mount for earlier hospital discharge of sicker patients, the importance of monitoring outcomes to assure patient safety increases.

Since the 1997 OPAT guidelines were published, some progress has been made in defining the appropriate outcomes to monitor and the techniques for their measurement; however, available data are sparse and rarely prospective [74, 75, 77, 129–138]. The articles referenced in the Appendix support the effectiveness of OPAT for many indications [11]. Recent studies have been published that demonstrate the effectiveness of OPAT for patients with osteomyelitis [131, 137, 139, 140] and children with complicated appendicitis [130]. Studies of pneumonia in patients with cystic fibrosis indicate at least comparable outcomes and higher patient satisfaction with OPAT than hospital care [7, 17, 18, 141–145]. Some studies show earlier return to normal function if hospital admission can be avoided [15, 146].

Adverse-event rates among patients receiving OPAT vary with the antimicrobial administered and the type and duration of placement of ("dwell time") the VAD [66]. For OPAT, as for hospital-administered antimicrobial therapy, adverse drug reactions occur with sufficient frequency to require continuous monitoring of data specific to the antimicrobial used [74, 75, 77].

OPAT centers should have an active performance improvement program that can track clinical and program outcomes. Limited data are available to allow for comparison of a program's performance with a national database for benchmarking purposes. The OPAT Outcomes Registry is a national database [135, 136, 147] that is accumulating data that can help compare a program's performance with that of an aggregate of >30 centers with over 14,000 cases [147–149]. An OPAT center collects data on outcomes for the patients and can monitor its own clinical performance over time. This is particularly useful in the absence of published outcomes standards for infections treated with OPAT. Parameters which are monitored in the OPAT Outcomes Registry are listed in table 8 [136, 147].

Patient safety and health care–related infections are of particular concern with OPAT. The home environment is rarely constructed for safety; hence, application of hospital infection control polices may not be appropriate. Fortunately, the risk of infection related to home care appears to be much less than the risk of hospital-acquired infection and the chances of acquiring an antimicrobial-resistant organism from the home environment appear to be lower [33, 66]. Long-term care facilities are challenged with a concentrated population of debilitated but mobile patients, many of whom are recovering from hospital-acquired infections [150].

Patient safety issues with OPAT are similar to the hospital with potential medication errors, adverse drug effects, and complications from infusion devices. Patients and staff should be educated with regard to these risks and be immediately available if they occur. OSHA standards for health care worker safety and needlestick prevention are to be incorporated into the patient's plan of care in the outpatient setting [151].

Considerations for Pediatric Patients

Although many of these guidelines apply to both adults and children, particular aspects of OPAT require some degree of specialization in the care of neonates, infants, and children. For this vulnerable population, safety should be the most important consideration. Although OPAT offers many advantages, it should not be undertaken in neonates, infants, or children unless care can be delivered to the child with the same or a greater degree of safety as provided by inpatient therapy. Certain competencies in physical examination are unique to pediatrics (e.g., assessment of seizures in a newborn infant with meningitis), certain infections are more common in children (including omphalitis, mastoiditis, and meningitis), and certain antimicrobial toxicities may be specific to children (e.g., fluoroquinolones and cartilage toxicity). Moreover, a family member other then the infected child must be capable of providing the necessary care. Some problems are unique to children, such as Munchausen syndrome by proxy. Literature on OPAT specific to children is not as extensive as literature on the outpatient treatment of adults, but a number of articles on pediatric therapy and complications have been written for community-acquired infections, meningitis, fever and neutropenia, and cystic fibrosis [130, 141, 145, 152–168].

An important difference of OPAT in pediatrics pertains to the nursing component of the team. In particular, the skills of physical assessment to evaluate the response to the infection and complications of the infection or medications clearly require experience and competence in the care of newborns, infants and children [166]. For the safety of the child, it is essential that the nursing provider be capable of a skilled assessment of the medical condition and response to treatment. In most situations, a registered nurse should provide nursing care, rather than a nurse's aide or a nursing assistant. The determination of competencies for the various levels of nursing, and the licensing procedures for nursing personnel are specific to each state. Physicians should be aware of the qualifications of the nursing personnel given responsibility for assessment of infants in their particular state. A nationally recognized pediatric infusion nurse society does not exist but the INCC certification examination does provide a component related to pediatrics [169]. Physicians, nurses, and pharmacy staff should all have proficiency and validated competency with the unique antimicrobials and dosing used for newborns, infants, and children to prevent errors in dosing or adverse drug events [170].

The need for home nursing visits in the majority of children follows the same guidelines as summarized for adults. However, in certain situations in which the clinical findings may be difficult to assess and the potential complications of the infection are great, daily visits by home care nurses may be required. Examples include infections during the neonatal period and CNS infections for children of any age. Both the qualifications of the visiting nurse for medical assessment of the child and authorization for the medically required number of nursing visits should be confirmed prior to discharge into an OPAT program. On occasion, direct communication with the medical director of a third party payor may be required to authorize the visits required for the safety of the infant or child. Similar to situations involving adults in which a caregiver is expected to administer antimicrobials, the competence of the parent or caregiver to administer medication and care for VADs should be demonstrated prior to beginning OPAT. Such preparation may avoid complications that result from parents or caregivers who are not capable of either a medical assessment, care of the child's catheter, or infusion of medication. The physician who discharges and treats the child as an outpatient has the ultimate responsibility for the intended outcome.

Selection of antimicrobials for children generally follows the same guidelines as those for inpatient parenteral therapy. However, the number of US Food and Drug Administration–approved antibacterials, antivirals, and antifungals for children is substantially fewer than those for adults, usually because of lack of data on efficacy and safety in children. As with inpatient management of pediatric infections, the physician must select the safest and most effective antimicrobials for the child. Selection of drugs with the least frequent dosing is an important consideration, as is the ability to administer the medication intramuscularly. Secure vascular access is essential before discharge as vascular access for an infant in the home with limited equipment resources and no support from other medical personnel may be difficult. Data on treatment of neonatal infections with newer agents is particularly limited. In general, sulfa-containing antibiotics are to be avoided during the neonatal period of physiologic jaundice. Fluoroquinolones are currently not used routinely in children because of concerns about cartilage toxicity.

The spectrum of equipment used for antimicrobial infusion in children is similar to adults, although some products are available specifically for children. The availability of vascular access by peripheral catheters, PICCs [68], and subcutaneously tunneled central catheters is virtually universal. A variety of infusion techniques are used in children, from direct injection of drugs via syringe (i.e., IV push administration) to infusion devices that vary from small kinetic “balloon” or elastomeric pumps to sophisticated electronic programmable infusion pumps.

Most of the outcome parameters for pediatric patients are similar to those for adults, even though the catheters and equipment used to administer medication, the antibiotics used, and the infections and pathogens treated may be unique to the pediatric age group. The complications and outcomes in one pediatric program should be compared with those of similar pediatric programs, rather than with adult programs. Improved standardization of definitions used for outcomes and reporting in pediatrics will make comparisons between institutions increasingly relevant and important.

Future Strategy

OPAT is now a standard part of medical practice in North America. Although it is commonplace, it is not without risk and responsibilities, especially for the physician, who must provide a quality of care with OPAT as good as that that would be provided if the patient remained hospitalized. It is also a method of delivery of medication that requires the expertise of and close coordination of services from physicians, nurses, pharmacists, and others.

The opportunities for further developing OPAT need to be explored with caution and ongoing assessments of effectiveness and patient safety. There are a number of ways by which information can be gathered concerning patient outcomes and the evolving trends in different health care organizations shared.

Additional studies of OPAT are needed in multiple areas. Randomized trials to answer important questions are rare. Vascular access is of continued concern, both with regard to device selection and ongoing care. The safety of midline catheters and PICCs in relation to peripheral short catheters for use with OPAT has not been studied fully. Policies for changing of catheters and dressings vary among providers, although guidelines and standards have been developed by the Infusion Nurses Society and the CDC that limit short peripheral catheter dwell time to 72 h [26, 37]. These recommendations were largely derived from hospital studies and may not always be appropriate for OPAT. Administration of antibiotics by IV push may save time but, in OPAT, its safety has not been documented. The complications associated with use of PICCs and the ability to recognize them early in the outpatient setting are of concern and require close monitoring. Concerns remain about infusing the first dose of an intravenous antibiotic in the home, especially because of the potential for anaphylaxis.

The answers to these questions can only be found through concentrated, cooperative efforts to gather and analyze data with the same rigor that applies in studies of therapy in hospitals. Clinical research on outcomes and patient safety issues can be accomplished through networks of providers and registries with outcomes information. These data can also be used to learn more about the optimal therapy for infectious diseases and about the agents used to treat them [147].

Final Comments

The contributors to these guidelines considered what could be done to optimize their understanding and use. Timely publication of the guidelines or their abstracts in the various society journals is possible. In addition, the Internet offers the ability to disseminate information and support it through links to documents from other societies and to patient education materials. The potential exists for continual updating and close cooperative activities among the societies represented in these guidelines. Many of these resources are available through the Web page of the Infectious Diseases Society of America (http://www.idsociety.org). Additional information about OPAT can be found at the OPAT Outcomes Registry Web site (http://www.opat.com) and at the Web pages of the contributing societies listed in table 9.

The future role of physicians in outpatient and home care is uncertain. Although their role in the hospital and office as specialists continues to be rewarded, their management of ancillary services and home care has significant disincentives [171]. Reimbursement mechanisms should be adjusted to recognize the added time and skill needed to manage these complex infections outside the hospital.

Acknowledgments

Advisors from related organizations who contributed to these guidelines include the following: Marianne Billeter, American Society of Health-System Pharmacists; Debbie Benvenuto, Infusion Nurses Society; Lynn Hadaway, Association for Vascular Access; Loretta Fauerbach, Association for Professionals in Infection Control and Epidemiology; Edward Ratner, American Academy of Home Care Physicians; and Lawrence Livornese, Jr., American College of Physicians–American Society of Internal Medicine.

Conflict of interest. J.S.B. has received research funding from Roche, AstraZeneca, Bristol-Myers Squibb, Johnson and Johnson, and Pfizer; he has consulted for AstraZeneca, Bristol-Myers Squibb, Johnson and Johnson, and Bayer. R.B.G. belongs to the speakers' bureaus of Roche, Merck, Pfizer, GlaxoSmithKline, and Wyeth-Ayerst. MJ.K. is employed by Pfizer.

Appendix

References

1
Antoniskis
A
Anderson
BC
Van Volkinburg
EJ
Jackson
JM
Gilbert
DN
Feasibility of outpatient self-administration of parenteral antibiotics
West J Med
 , 
1978
, vol. 
128
 (pg. 
203
-
6
)
2
Grayson
ML
Silvers
J
Turnidge
J
Home intravenous antibiotic therapy: a safe and effective alternative to inpatient care
Med J Aust
 , 
1995
, vol. 
162
 (pg. 
249
-
53
)
3
Kayley
J
Berendt
AR
Snelling
MJM
, et al.  . 
Antimicrobial practice. Safe intravenous antibiotic therapy at home: experience of a UK based program
J Antimicrob Chemother
 , 
1996
, vol. 
37
 (pg. 
1023
-
9
)
4
Kind
AC
Williams
DN
Persons
G
Gibson
JA
Intravenous antibiotic therapy at home
Arch Intern Med
 , 
1979
, vol. 
139
 (pg. 
413
-
5
)
5
Poretz
DM
Eron
LJ
Goldenberg
RI
, et al.  . 
Intravenous antibiotic therapy in an outpatient setting
JAMA
 , 
1982
, vol. 
248
 (pg. 
336
-
9
)
6
Rehm
SJ
Weinstein
AJ
Home intravenous antibiotic therapy: a team approach
Ann Intern Med
 , 
1983
, vol. 
99
 (pg. 
388
-
92
)
7
Rucker
RW
Harrison
GM
Outpatient intravenous medications in the management of cystic fibrosis
Pediatrics
 , 
1974
, vol. 
54
 (pg. 
358
-
60
)
8
Tice
AD
An office model of outpatient parenteral antibiotic therapy
Rev Infect Dis
 , 
1991
, vol. 
13
 
Suppl 2
(pg. 
184
-
8
)
9
Winter
RJD
George
R
Deacock
S
, et al.  . 
Self-administered home intravenous antibiotic therapy in bronchiectasis and adult cystic fibrosis
Lancet
 , 
1984
, vol. 
1
 (pg. 
1338
-
9
)
10
Winters
RW
Parver
AK
Sansbury
JD
Home infusion therapy: a service and demographic profile: a report for the National Alliance for Infusion Therapy
 , 
1992
Washington, DC
National Alliance for Infusion Therapy
(pg. 
1
-
61
)
11
Williams
DN
Rehm
SJ
Tice
AD
Bradley
JS
Kind
AC
Craig
WA
Practice guidelines for community-based parenteral anti-infective therapy
Clin Infect Dis
 , 
1997
, vol. 
25
 (pg. 
787
-
801
)
12
Tice
AD
Outpatient parenteral antibiotic therapy: management of serious infections. I. Medical, socioeconomic, and legal issues: the team concept
Hosp Pract (Off Ed)
 , 
1993
, vol. 
28
 
Suppl 1
(pg. 
6
-
10
)
13
Bartlett
JG
Dowell
SF
Mandell
LA
File
TM
Jr
Musher
DM
Fine
MJ
Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America
Clin Infect Dis
 , 
2000
, vol. 
31
 (pg. 
347
-
82
)
14
Auble
TE
Yealy
DM
Fine
MJ
Assessing prognosis and selecting an initial site of care for adults with community-acquired pneumonia
Infect Dis Clin North Am
 , 
1998
, vol. 
12
 (pg. 
741
-
59
)
15
McCormick
D
Fine
MJ
Coley
CM
, et al.  . 
Variation in length of hospital stay in patients with community-acquired pneumonia: are shorter stays associated with worse medical outcomes?
Am J Med
 , 
1999
, vol. 
107
 (pg. 
5
-
12
)
16
Niederman
MS
Bass
JB
Campbell
GD
, et al.  . 
Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy
Am Rev Respir Dis
 , 
1993
, vol. 
148
 (pg. 
1418
-
26
)
17
Fine
MJ
Hough
LJ
Medsger
AR
, et al.  . 
The hospital admission decision for patients with community-acquired pneumonia
Arch Intern Med
 , 
1997
, vol. 
157
 (pg. 
36
-
44
)
18
Fine
MJ
Medsger
AR
Stone
RA
, et al.  . 
The hospital discharge decision for patients with community-acquired pneumonia
Arch Intern Med
 , 
1997
, vol. 
157
 (pg. 
47
-
56
)
19
Rehm
SJ
Outpatient intravenous antibiotic therapy for endocarditis
Infect Dis Clin North Am
 , 
1998
, vol. 
12
 (pg. 
879
-
901
)
20
Francioli
P
Etienne
J
Hoigne
R
Thys
JP
Gerber
A
Treatment of streptococcal endocarditis with a single daily dose of ceftriaxone sodium for 4 weeks: efficacy and outpatient treatment feasibility
JAMA
 , 
1992
, vol. 
267
 (pg. 
264
-
7
)
21
Stamboulian
D
Bonvehi
P
Arevalo
C
, et al.  . 
Antibiotic management of outpatients with endocarditis due to penicillin-susceptible streptococci
Rev Infect Dis
 , 
1991
, vol. 
13
 (pg. 
160
-
3
)
22
Sexton
DJ
Tenenbaum
MJ
Wilson
WR
, et al.  . 
Ceftriaxone once daily for four weeks compared with ceftriaxone plus gentamicin once daily for two weeks for treatment of endocarditis due to pencillin-susceptible streptococci. Endocarditis Treatment Consortium Group
Clin Infect Dis
 , 
1998
, vol. 
27
 (pg. 
1470
-
4
)
23
Andrews
MM
von Reyn
CF
Patient selection criteria and management guidelines for outpatient parenteral antibiotic therapy for native valve infective endocarditis
Clin Infect Dis
 , 
2001
, vol. 
33
 (pg. 
203
-
9
)
24
Brown
RB
Selection and training of patients for outpatient intravenous antibiotic therapy
Rev Infect Dis
 , 
1991
, vol. 
13
 (pg. 
147
-
51
)
25
Poretz
DM
Home management of antibiotic therapy
Curr Clin Top Infect Dis
 , 
1989
, vol. 
10
 (pg. 
27
-
42
)
26
Infusion Nurses Society
Infusion nursing standards of practice
J Intraven Nurs
 , 
2002
, vol. 
23
 
Suppl 6
(pg. 
1
-
88
)
27
Chung
M
Akahoshi
M
Reducing home nursing visit costs using a remote access infusion pump system
J Intraven Nurs
 , 
1999
, vol. 
22
 (pg. 
309
-
14
)
28
DeMaio
J
Schwartz
L
Cooley
P
Tice
AD
The application of telemedicine technology to a directly observed therapy program for tuberculosis: a pilot project
Clin Infect Dis
 , 
2001
, vol. 
33
 (pg. 
2082
-
4
)
29
Nolet
BR
Patient selection in outpatient parenteral antimicrobial therapy
Infect Dis Clin North Am
 , 
1998
, vol. 
12
 (pg. 
835
-
47
)
30
Miller
Z
Health maintenance organization
Hosp Pract
 , 
1993
, vol. 
28
 
Suppl 2
(pg. 
44
-
47
)
31
Hankwitz
PE
Keenan
JM
The expanding and increasingly important role of the home health care agency medical director
Am Ac Home Care Phys Newsletter
 , 
1994
, vol. 
6
 (pg. 
8
-
10
)
32
Goldberg
AI
Gardner
HG
Gibson
LE
Home care: the next frontier of pediatric practice
J Pediatr
 , 
1994
, vol. 
125
 (pg. 
686
-
90
)
33
Tice
AD
Growing pains in outpatient intravenous antibiotic therapy
Infect Dis Clin Pract
 , 
1993
, vol. 
1
 (pg. 
74
-
6
)
34
American Society of Hospital Pharmacists (ASHP)
ASHP statement on the pharmacist's role with respect to drug delivery systems and administration devices
Am J Hosp Pharm
 , 
1993
(pg. 
1724
-
5
)
35
American Society of Health-System Pharmacists (ASHP)
ASHP guidelines on the pharmacist's role in home care
Am J Health Syst Pharm
 , 
2000
, vol. 
57
 (pg. 
1252
-
7
)
36
Wickline v State of California, 228 Cal. Rptr. 661, 192. Cap. App. 3d 1630
 , 
1986
37
Physicians, surgeons and other healers. American Jurisprudence
 , 
1981
2d ed.
Rochester, NY
Lawyers' Cooperative Publishing Company
pg. 
226
 
38
Tice
AD
Nolet
BR
Delivery models for outpatient parenteral antimicrobial therapy. In: Outpatient parenteral antimicrobial therapy: current status
Scientific American Medicine special report
 , 
1997
(pg. 
7
-
11
)
39
Bakken
JS
Conlon
CP
Smerud
KT
Vinen
JD
Wijlhuizen
TG
Antibiotic administration options
Infect Dis Clin Pract
 , 
1996
, vol. 
5
 (pg. 
66
-
7
)
40
Nathwani
D
Seaton
A
Davey
P
Key issues in the development of a non-inpatient intravenous (NIPIV) antibiotic therapy programme—a European perspective
Rev Med Microbiol
 , 
1997
, vol. 
8
 (pg. 
137
-
47
)
41
Nathwani
D
Conlon
CP
Outpatient and home parenteral antibiotic therapy (OHPAT) in the UK: a consensus statement by a working party
Clin Microbiol Infect
 , 
1998
, vol. 
4
 (pg. 
537
-
51
)
42
Tice
AD
The importance of teamwork for outpatient parenteral antibiotic therapy
Int J Antimicrob Agents
 , 
1995
, vol. 
5
 (pg. 
13
-
7
)
43
Williams
DN
Raymond
JL
Practice guidelines for community-based parenteral anti-infective therapy
Infect Dis Clin North Am
 , 
1998
, vol. 
12
 (pg. 
1009
-
21
)
44
Residency Review Committee
Specific program content. CAAR Program Information from Workshop for Internal Medicine Subspecialty Residencies in Infectious Disease. 11. 2001. American Board of Internal Medicine. Ref Type: Conference Proceeding.
 
45
Lonsway
RAW
Hankins
J
Lonsway
RAW
Hedrick
C
Perdue
MD
Intravenous therapy in the home
Infusion therapy in clinical practice
 , 
2001
2d ed.
Philadelphia
W.B. Saunders
(pg. 
501
-
34
)
46
Mortlock
N
Como
D
Myers
T
Intravenous therapy in the alternative care setting
Infusion therapy in clinical practice
 , 
2001
Philadelphia
W.B. Saunders
(pg. 
535
-
60
)
47
Williams
DN
Raymond
JL
Community-based parenteral anti-infective therapy (CoPAT): pharmacokinetic and monitoring issues
Clinical Pharmacokinetics
 , 
1998
, vol. 
35
 (pg. 
65
-
77
)
48
US Public Health Service
Updated US Public Health Service Guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis
MMWR Morb Mortal Wkly Rep
 , 
2001
, vol. 
50
 
RR-11
(pg. 
1
-
52
)
49
Tice
AD
Bloodborne pathogen exposure and recommendations for management
J Infus Nurs
 , 
2002
, vol. 
25
 
Suppl 6
(pg. 
5
-
9
)
50
Meehan
TP
Fine
MJ
Krumholz
HM
, et al.  . 
Quality of care, process, and outcomes in elderly patients with pneumonia
JAMA
 , 
1997
, vol. 
278
 (pg. 
2080
-
4
)
51
Battleman
DS
Callahan
M
Thaler
HT
Rapid antibiotic delivery and appropriate antibiotic selection reduce length of hospital stay of patients with community-acquired pneumonia: link between quality of care and resource utilization
Arch Intern Med
 , 
2002
, vol. 
162
 (pg. 
682
-
8
)
52
Norgard
B
Sorensen
HT
Jensen
ES
Faber
T
Schonheyder
HC
Nielsen
GL
Pre-hospital parenteral antibiotic treatment of meningococcal disease and case fatality: a Danish population-based cohort study
J Infect
 , 
2002
, vol. 
45
 (pg. 
144
-
51
)
53
Chemaly
RF
de Parres
JB
Rehm
SJ
, et al.  . 
Venous thrombosis associated with peripherally inserted central catheters: a retrospective analysis of the Cleveland Clinic experience
Clin Infect Dis
 , 
2002
, vol. 
34
 (pg. 
1179
-
83
)
54
Garrelts
JC
Ast
D
LaRocca
J
Smith
DF
Peterie
JD
Postinfusion phlebitis after intravenous push versus intravenous piggyback administration of antimicrobial agents
Clin Pharm
 , 
1988
, vol. 
7
 (pg. 
760
-
5
)
55
Nowobilski-Vasilios
A
Poole
SM
Development and preliminary outcomes of a program for administering antimicrobials by i.v. push in home care
Am J Health Syst Pharm
 , 
1999
, vol. 
56
 (pg. 
76
-
9
)
56
Skokal
W
IV push at home?
RN
 , 
2000
, vol. 
63
 (pg. 
26
-
9
)
57
Dew
RI
Sulsa
G
Once-daily aminoglycoside treatment
Infect Dis Clin Pract
 , 
1996
, vol. 
5
 (pg. 
12
-
24
)
58
McNulty
TJ
Home care exchange: initiation of antimicrobial therapy in the home
Am J Hosp Pharm
 , 
1993
, vol. 
50
 (pg. 
773
-
4
)
59
Tulkens
PM
Pharmacokinetic and toxicological evaluation of a once-daily regimen versus conventional schedules of netilmicin and amikacin
J Antimicrob Chemother
 , 
1991
, vol. 
27
 
Suppl C
(pg. 
49
-
61
)
60
Craig
WA
Antibiotic selection factors and description of a hospital-based outpatient antibiotic therapy program in the USA
Eur J Clin Microbiol Infect Dis
 , 
1995
, vol. 
14
 (pg. 
636
-
42
)
61
Craig
WA
Ebert
SC
Continuous infusion of beta-lactam antibiotics
Antimicrob Agents Chemother
 , 
1992
, vol. 
36
 pg. 
2577
 
62
Cutler
NR
Narang
PK
Lesko
LJ
Ninos
M
Power
M
Vancomycin disposition: the importance of age
Clin Pharmacol Ther
 , 
1984
, vol. 
36
 (pg. 
803
-
10
)
63
Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC)
Am J Infect Control
 , 
1995
, vol. 
23
 (pg. 
87
-
94
)
64
Centers for Disease Control Prevention
Staphylococcus aureus resistant to vancomycin—United States, 2002
MMWR Morb Mortal Wkly Rep
 , 
2002
, vol. 
51
 (pg. 
565
-
7
)
65
Barton
AJ
Danek
G
Johns
P
Coons
M
Improving patient outcomes through CQI: vascular access planning
J Nurs Care Qual
 , 
1998
, vol. 
13
 (pg. 
77
-
85
)
66
Graham
DR
Keldermans
MM
Klemm
LW
Semenza
NJ
Shafer
ML
Infectious complications among patients receiving home intravenous therapy with peripheral, central, or peripherally placed central venous catheters
Am J Med
 , 
1991
, vol. 
91
 (pg. 
95
-
100
)
67
Ng
PK
Ault
MD
Ellrodt
AG
Maldonado
L
Peripherally inserted central catheters in general medicine
Mayo Clin Proc
 , 
1997
, vol. 
72
 (pg. 
225
-
33
)
68
Thiagarajan
RR
Ramamoorthy
C
Gettmann
T
Bratton
SL
Survey of the use of peripherally inserted central venous catheters in children
Pediatrics
 , 
1997
, vol. 
99
 pg. 
4
 
69
National Association of Vascular Access Networks
Tip location of peripherally inserted central catheters
J Vascular Access Devices
 , 
1998
, vol. 
3
 (pg. 
8
-
10
)
70
Racadio
JM
Doellman
DA
Johnson
ND
Bean
JA
Jacobs
BR
Pediatric peripherally inserted central catheters: complication rates related to catheter tip location
Pediatrics
 , 
2001
, vol. 
107
 pg. 
28
 
71
Allen
AW
Megargell
JL
Brown
DB
, et al.  . 
Venous thrombosis associated with the placement of peripherally inserted central catheters
J Vasc Interv Radiol
 , 
2000
, vol. 
11
 (pg. 
1309
-
14
)
72
James
L
Bledsoe
L
Hadaway
LC
A retrospective look at tip location and complications of peripherally inserted central catheter lines
J Intraven Nurs
 , 
1993
, vol. 
16
 (pg. 
104
-
9
)
73
Tice
AD
Seibold
G
Martinelli
LP
Adverse effects with intravenous antibiotics with OPAT
Program and abstracts of the 40th Annual Meeting of the Infectious Diseases Society of America (IDSA) (Chicago) [abstract 59]
 , 
2002
Alexandria, VA
IDSA
74
Hoffman-Terry
ML
Fraimow
HS
Fox
TR
Swift
BG
Wolf
JE
Adverse effects of outpatient parenteral antibiotic therapy
Am J Med
 , 
1999
, vol. 
106
 (pg. 
44
-
9
)
75
Berman
SJ
Johnson
EW
Out-patient parenteral antibiotic therapy (OPAT): clinical outcomes and adverse events
Hawaii Med J
 , 
2001
, vol. 
60
 (pg. 
31
-
3
)
76
Cunha
BA
Antibiotic side effects
Med Clin North Am
 , 
2001
, vol. 
85
 (pg. 
149
-
85
)
77
Rehm
SJ
Longworth
DL
Rates of adverse events associated with community-based parenteral anti-infective therapy
J Clin Outcomes Manage
 , 
2000
, vol. 
7
 (pg. 
23
-
8
)
78
Nicolau
DP
Freeman
CD
Belliveau
PP
Nightingale
CH
Ross
JW
Quintiliani
R
Experience with a once-daily aminoglycoside program administered to 2,184 adult patients
Antimicrob Agents Chemother
 , 
1995
, vol. 
39
 (pg. 
650
-
5
)
79
Urban
AW
Craig
WA
Daily dosage of aminoglycosides
Curr Clin Top Infect Dis
 , 
1997
, vol. 
17
 (pg. 
236
-
55
)
80
Contreras
AM
Gamba
G
Cortes
J
, et al.  . 
Serial trough and peak amikacin levels in plasma as predictors of nephrotoxicity
Antimicrob Agents Chemother
 , 
1989
, vol. 
33
 (pg. 
973
-
6
)
81
Bertino
JSJ
Booker
LA
Franck
PA
Jenkins
PL
Franck
KR
Nafziger
AN
Incidence of and significant risk factors for aminoglycoside-associated nephrotoxicity in patients dosed by using individualized pharmacokinetic monitoring
J Infect Dis
 , 
1993
, vol. 
167
 (pg. 
173
-
9
)
82
Moore
RD
Smith
CR
Lietman
PS
Risk factors for the development of auditory toxicity in patients receiving aminoglycosides
J Infect Dis
 , 
1984
, vol. 
149
 (pg. 
23
-
30
)
83
Paterson
DL
Robson
JM
Wagener
MM
Risk factors for toxicity in elderly patients given aminoglycoside once daily
J Gen Intern Med
 , 
1998
, vol. 
13
 (pg. 
735
-
9
)
84
Minor
LB
Gentamicin-induced bilateral vestibular hypofunction
JAMA
 , 
1998
, vol. 
279
 (pg. 
541
-
4
)
85
Demer
JL
Honrubia
V
Baloh
RW
Dynamic visual acuity: a test for oscillopsia and vestibulo-ocular reflex function
Am J Otol
 , 
1994
, vol. 
15
 (pg. 
340
-
7
)
86
Longridge
NS
Mallinson
AI
The dynamic illegible E-test: a technique for assessing the vestibulo-ocular reflex
Acta Otolaryngol
 , 
1987
, vol. 
103
 (pg. 
273
-
9
)
87
Brummett
RE
Morrison
RB
The incidence of aminoglycoside antibiotic-induced hearing loss
Arch Otolaryngol Head Neck Surg
 , 
1990
, vol. 
116
 (pg. 
406
-
10
)
88
Martinelli
L
Aminoglycoside questionnaire results
OPIVITA Newsletter
 , 
1988
89
Davey
PG
Jabeen
FJ
Harpur
ES
Shenoi
PM
Geddes
AM
A controlled study of the reliability of pure tone audiometry for the detection of gentamicin auditory toxicity
J Laryngol Otol
 , 
1983
, vol. 
97
 (pg. 
27
-
36
)
90
Cantu
TG
Yamanaka-Yuen
NA
Lietman
PS
Serum vancomycin concentrations: reappraisal of their clinical value
Clin Infect Dis
 , 
1994
, vol. 
18
 (pg. 
533
-
43
)
91
Tobin
CM
Darville
JM
Thomson
AH
, et al.  . 
Vancomycin therapeutic drug monitoring: is there a consensus view? The results of a UK National External Quality Assessment Scheme (UK NEQAS) for Antibiotic Assays questionnaire
J Antimicrob Chemother
 , 
2002
, vol. 
50
 (pg. 
713
-
8
)
92
Fernandez de Gatta
MD
Calvo
MV
Hernandez
JM
Caballero
D
San Miguel
JF
Dominguez-Gil
A
Cost-effectiveness analysis of serum vancomycin concentration monitoring in patients with hematologic malignancies
Clin Pharmacol Ther
 , 
1996
, vol. 
60
 (pg. 
332
-
40
)
93
Rybak
MJ
Boike
SC
Monitoring vancomycin therapy
Drug Intell Clin Pharm
 , 
1986
, vol. 
20
 (pg. 
757
-
61
)
94
Gendeh
BS
Gibb
AG
Aziz
NS
Kong
N
Zahir
ZM
Vancomycin administration in continuous ambulatory peritoneal dialysis: the risk of ototoxicity
Otolaryngol Head Neck Surg
 , 
1998
, vol. 
118
 (pg. 
551
-
8
)
95
de Hoog
M
van Zanten
BA
Hop
WC
Overbosch
E
Weisglas-Kuperus
N
van den Anker
JN
Newborn hearing screening: tobramycin and vancomycin are not risk factors for hearing loss
J Pediatr
 , 
2003
, vol. 
142
 (pg. 
41
-
6
)
96
Bhatt-Mehta
V
Schumacher
RE
Faix
RG
Leady
M
Brenner
T
Lack of vancomycin-associated nephrotoxicity in newborn infants: a case-control study
Pediatrics
 , 
1999
, vol. 
103
 pg. 
48
 
97
Sorrell
TC
Collignon
PJ
A prospective study of adverse reactions associated with vancomycin therapy
J Antimicrob Chemother
 , 
1985
, vol. 
16
 (pg. 
235
-
41
)
98
Karam
CM
McKinnon
PS
Neuhauser
MM
Rybak
MJ
Outcome assessment of minimizing vancomycin monitoring and dosing adjustments
Pharmacotherapy
 , 
1999
, vol. 
19
 (pg. 
257
-
66
)
99
Kralovicova
K
Spanik
S
Halko
J
Netriova
J
Studena-Mrazova
M
Novotny
J
Do serum vancomycin levels predict failures of vancomycin therapy or nephrotoxicity in cancer patients?
J Chemother
 , 
1997
, vol. 
9
 (pg. 
420
-
6
)
100
Knudsen
JD
Fuursted
K
Raber
S
Espersen
F
Frimodt-Moller
N
Pharmacodynamics of glycopeptides in the mouse peritonitis model of Streptococcus pneumoniae or Staphylococcus aureus infection
Antimicrob Agents Chemother
 , 
2000
, vol. 
44
 (pg. 
1247
-
54
)
101
Zokufa
HZ
Rodvold
KA
Blum
RA
, et al.  . 
Simulation of vancomycin peak and trough concentrations using five dosing methods in 37 patients
Pharmacotherapy
 , 
1989
, vol. 
9
 (pg. 
10
-
16
)
102
Rodman
DP
McKnight
JT
Rogers
T
Robbins
M
The appropriateness of initial vancomycin dosing
J Fam Pract
 , 
1994
, vol. 
38
 (pg. 
473
-
7
)
103
Pryka
RD
Rodvold
KA
Garrison
M
Rotschafer
JC
Individualizing vancomycin dosing regimens: one- versus two-comparment Bayesian models
Ther Drug Monit
 , 
1998
, vol. 
11
 (pg. 
450
-
4
)
104
Pea
F
Prooeca
L
Baraldo
M
Furlanut
M
High vancomycin dosage regimens required by intensive care unit patients cotreated with drugs to improve haemodynamics following cardiac surgical procedures
J Antimicrob Chemother
 , 
2000
, vol. 
45
 (pg. 
329
-
35
)
105
Penzak
SR
Gubbins
PO
Rodvold
KA
Hickerson
SL
Therapeutic drug monitoring of vancomycin in a morbidly obese patient
Ther Drug Monit
 , 
1998
, vol. 
20
 (pg. 
261
-
5
)
106
Gous
AG
Dance
MD
Lipman
J
Luyt
DK
Mathivha
R
Scribante
J
Changes in vancomycin pharmacokinetics in critically ill infants
Anaesth Intensive Care
 , 
1995
, vol. 
23
 (pg. 
678
-
82
)
107
Reed
RL
II
Wu
AH
Miller-Crotchett
P
Crotchett
J
Fischer
RP
Pharmacokinetic monitoring of nephrotoxic antibiotics in surgical intensive care patients
Trauma
 , 
1989
, vol. 
29
 (pg. 
1462
-
8
)
108
Rodvold
KA
Everett
JA
Pryka
RD
Kraus
DM
Pharmacokinetics and administration regimens of vancomycin in neonates, infants and children
Clin Pharmacokinet
 , 
1997
, vol. 
33
 (pg. 
32
-
51
)
109
Taber
DJ
Fann
AL
Malat
G
Dupuis
RE
Evaluation of estimated and measured ceratinine clearances for predicting ther pharmacokinetics of vancomycin in adult liver transplant recipients
Ther Drug Monit
 , 
2003
, vol. 
25
 (pg. 
67
-
72
)
110
Bearden
DT
Rodvold
KA
Dosage adjustments for antibacterials in obese patients: applying pharamacokinetics
Clin Pharmacokinet
 , 
2000
, vol. 
38
 (pg. 
5
-
26
)
111
Miles
MV
Li
L
Lakkis
H
Youngblood
J
McGinnis
P
Special considerations for monitoring vancomycin concentrations in pediatric patients
Ther Drug Monit
 , 
1997
, vol. 
19
 (pg. 
265
-
70
)
112
Le Normand
Y
Milpied
N
Kergueris
MF
Harousseau
JL
Pharmacokinetic parameters of vancomycin for therapeutic regimens in neutropenic adult patients
Int J Biomed Comput
 , 
1994
, vol. 
36
 (pg. 
121
-
5
)
113
Guay
DR
Vance-Bryan
K
Gilliland
S
Roddvoid
K
Rotschafer
JC
Comparision of vancomycin pharmacokinetics in hospitalized elderly and young patients using a Bayesian forecaster
J Clin Pharmacol
 , 
1993
, vol. 
33
 (pg. 
918
-
22
)
114
Asbury
WH
Darsey
EH
Rose
WB
Murphy
JE
Buffington
DE
Capers
CC
Vancomycin pharmacokinetics in neonates and infants: a retrospective evaluation
Ann Pharmacother
 , 
1993
, vol. 
27
 (pg. 
490
-
6
)
115
Garrelts
JC
Peterie
JD
Altered vancomycin dose vs. serum concentration relationship in burn patients
Clin Pharmacol Ther
 , 
1988
, vol. 
44
 (pg. 
9
-
13
)
116
Pou
L
Rosell
M
Lopez
R
Pascual
C
Changes in vancomycin pharmacokinetics during treatment
Ther Drug Monit
 , 
1996
, vol. 
18
 (pg. 
149
-
53
)
117
Schentag
JJ
Antimicrobial action and phamacokinetics/pharmacodynamics: the use of AUIC to improve efficacy and avoid resistance
J Chemother
 , 
1999
, vol. 
11
 (pg. 
426
-
39
)
118
Hautekeete
ML
Hepatotoxicity of antibitoics
Acta Gastroenterol Belg
 , 
1995
, vol. 
58
 (pg. 
290
-
6
)
119
Kuter
DJ
Tillotson
GS
Hematologic effects of antimicrobials: focus on the oxazolidinone linezolid
Pharmacotherapy
 , 
2001
, vol. 
21
 (pg. 
1010
-
3
)
120
Peralta
FG
Sanchez
MB
Roiz
MP
Pena
MA
Tejero
MA
Arjona
R
Incidence of neutropenia during treatment of bone-related infections with piperacillin-tazobactam
Clin Infect Dis
 , 
2003
, vol. 
37
 (pg. 
1568
-
72
)
121
Cobos
E
Dixon
S
Keung
YK
Prevention and management of central venous catheter thrombosis
Curr Opin Hematol
 , 
1998
, vol. 
5
 (pg. 
355
-
9
)
122
Centers for Disease Control Prevention
Guidelines for the prevention of intravascular catheter-related infections
MMWR Morb Mortal Wkly Rep
 , 
2002
, vol. 
51
 
RR-10
(pg. 
1
-
29
)
123
Mermel
LA
Farr
BM
Sherertz
R
, et al.  . 
Guidelines for the management of intravascular catheter-related infections
Clin Infect Dis
 , 
2001
, vol. 
32
 (pg. 
1249
-
72
)
124
Lee
AY
Ginsberg
JS
Venous thrombosis of the upper extremities
Current Treatment Options in Cardiovascular Medicine
 , 
2001
, vol. 
3
 (pg. 
207
-
14
)
125
Bregenzer
T
Conen
D
Sakmann
P
Widmer
AF
Is routine replacement of peripheral intravenous catheters necessary?
Arch Intern Med
 , 
1998
, vol. 
158
 (pg. 
151
-
6
)
126
Tice
AD
Pharmacoeconomic considerations in the ambulatory use of parenteral cephalosporins
Drugs
 , 
2000
, vol. 
59
 (pg. 
29
-
35
)
127
Popovich
ML
Sentinel events in home care and hospice organizations
Home Care Provid
 , 
2000
, vol. 
5
 (pg. 
78
-
80
)
128
2000–2001 Comprehensive accreditation manual for ambulatory care
 , 
1999
Oakbrook Terrace, IL
Joint Commission on Accreditation for Healthcare Organizations
129
Barrell
JM
ORYX: outcomes measurement and accreditation
Infusion
 , 
1998
, vol. 
May
 (pg. 
37
-
9
)
130
Bradley
JS
Behrendt
CE
Arrieta
AC
, et al.  . 
Convalescent phase outpatient parenteral antiinfective therapy for children with complicated appendicitis
Pediatr Infect Dis J
 , 
2001
, vol. 
20
 (pg. 
19
-
24
)
131
Guglielmo
BJ
Luber
AD
Paletta
D
Jacobs
RA
Ceftriaxone therapy for staphylococcal osteomyelitis: a review
Clin Infect Dis
 , 
2000
, vol. 
30
 (pg. 
205
-
7
)
132
Kunkel
MJ
Quality assurance and outcomes in outpatient parenteral antibiotic therapy
Infect Dis Clin North Am
 , 
1998
, vol. 
12
 (pg. 
1023
-
34
)
133
Poole
SM
Vasilios
AN
Outcomes measurements: making sense of the data
Infusion
 , 
1998
, vol. 
May
 (pg. 
25
-
8
)
134
Tice
AD
Patient selection criteria for outpatient parenteral antibiotic therapy: experience with a physician-directed, clinic-based program for outpatient parenteral antibiotic therapy in the USA
Eur J Clin Microbiol Infect Dis
 , 
1995
, vol. 
14
 (pg. 
655
-
61
)
135
Tice
AD
Documenting the value of OPAT: outcomes studies and patient registries
Can J Infect Dis
 , 
2000
, vol. 
10
 (pg. 
45
-
8A
)
136
Tice
AD
Schleis
TG
Nolet
BR
Hoaglund
PA
Kunkel
MJ
Page
US
Outcomes registry for outpatient IV antimicrobial therapy
Infusion
 , 
2000
, vol. 
May
 (pg. 
27
-
35
)
137
Tice
AD
The use of outpatient parenteral antimicrobial therapy in the management of osteomyelitis: data from the outpatient parenteral antimicrobial therapy outcomes registry
Chemotherapy
 , 
2001
, vol. 
47
 (pg. 
5
-
16
)
138
Williams
DN
Home intravenous antibiotic therapy (HIVAT): indications, patients and antimicrobial agents
Int J Antimicrob Agents
 , 
1995
, vol. 
5
 (pg. 
3
-
8
)
139
Tice
AD
Hoaglund
PA
Shoultz
DA
Outcomes of osteomyelitis among patients treated with outpatient parenteral antimicrobial therapy
Am J Med
 , 
2003
, vol. 
114
 (pg. 
723
-
8
)
140
Tice
AD
Hoaglund
PA
Shoultz
DA
Risk factors and treatment outcomes in osteomyelitis
J Antimicrob Chemother
 , 
2003
, vol. 
51
 (pg. 
1261
-
8
)
141
Donati
MA
Guenette
G
Auerbach
H
Prospective controlled study of home and hospital therapy of cystic fibrosis pulmonary disease
J Pediatr
 , 
1987
, vol. 
111
 (pg. 
28
-
33
)
142
Hjelte
L
Widen
B
Malmborg
AS
Freyschuss
U
Strandvik
B
Intravenous administration of antibiotics at home in patients with cystic fibrosis improves quality of life
Lakartidningen
 , 
1988
, vol. 
85
 (pg. 
1614
-
7
)
143
Kuzemko
JA
Home treatment of pulmonary infection in cystic fibrosis
Chest
 , 
1988
, vol. 
94
 (pg. 
162
-
166
)
144
Strandvik
B
Hjelte
L
Malmborg
AS
Widen
B
Home intravenous antibiotic treatment of patients with cystic fibrosis
Acta Paediatr
 , 
1992
, vol. 
81
 (pg. 
340
-
4
)
145
Wolter
JM
Bowler
SD
Nolan
PJ
McCormack
JG
Home intravenous therapy in cystic fibrosis: a prospective randomized trial examining clinical, quality of life and cost aspects
Eur Respir J
 , 
1997
, vol. 
10
 (pg. 
896
-
900
)
146
Caplan
GA
Ward
JA
Brennan
NJ
Coconis
J
Board
N
Brown
A
Hospital in the home: a randomised controlled trial
MJA
 , 
1999
, vol. 
170
 (pg. 
156
-
60
)
147
Nathwani
D
Tice
AD
Ambulatory antimicrobial use: the value of an outcomes registry
J Antimicrob Chemother
 , 
2002
, vol. 
49
 (pg. 
149
-
54
)
148
Outpatient Parenteral Antimicrobial Therpay Outcomes Registry Web site
  
Available at: http://www.opat.com
149
Tice
AD
Seibold
G
Martinelli
LP
Reasons for failures with OPAT [abstract 293]
Program and abstracts of the 41st Annual Meeting of the Infectious Diseases Society of America (IDSA) (San Diego, CA)
 , 
2003
Alexandria, VA
IDSA
150
Crossley
K
Long-term care facilities as sources of antibiotic-resistant nosocomial pathogens
Curr Opin Infect Dis
 , 
2001
, vol. 
14
 (pg. 
455
-
9
)
151
Tice
AD
Barrett
T
Abrutyn
E
Goldmann
DA
Scheckler
WE
Home health care
Saunders infection control reference service
 , 
2000
Philadelphia
W.B. Saunders
(pg. 
151
-
154
)
152
Arditi
M
Yogev
R
Convalescent outpatient therapy for selected children with acute bacterial meningitis
Semin Pediatr Infect Dis
 , 
1990
, vol. 
1
 (pg. 
404
-
10
)
153
Bradley
JS
Ching
DK
Phillips
SE
Outpatient therapy of serious pediatric infections with ceftriaxone
Pediatr Infect Dis J
 , 
1988
, vol. 
7
 (pg. 
160
-
4
)
154
Bradley
JS
Ching
DL
Wilson
TA
Compogiannis
LS
Once-daily ceftriaxone to complete therapy of uncomplicated group B streptococcal infection in neonates. A preliminary report
Clin Pediatr
 , 
1992
, vol. 
31
 (pg. 
274
-
8
)
155
Dagan
R
Phillip
M
Watemberg
NM
Kassis
I
Outpatient treatment of serious community-acquired pediatric infections using once-daily intramuscular ceftriaxone
Pediatr Infect Dis J
 , 
1987
, vol. 
6
 (pg. 
1080
-
4
)
156
Goldenberg
RI
Poretz
DM
Eron
LJ
Rising
JB
Sparks
SB
Intravenous antibiotic therapy in ambulatory pediatric patients
Pediatr Infect Dis
 , 
1984
, vol. 
3
 (pg. 
514
-
7
)
157
Gomez
M
Maraqa
N
Alvarez
A
Rathore
M
Complications of outpatient parenteral antibiotic therapy in childhood
Pediatr Infect Dis J
 , 
2001
, vol. 
20
 (pg. 
541
-
3
)
158
Gutierrez
K
Continuation of antibiotic therapy for serious bacterial infections outside of the hospital
Pediatr Ann
 , 
1996
, vol. 
25
 (pg. 
639
-
45
)
159
Hooker
L
Kohler
J
Safety, efficacy, and acceptability of home intravenous therapy administration by parents of pediatric oncology patients
Med Pediatr Oncol
 , 
1999
, vol. 
32
 (pg. 
421
-
6
)
160
Leaver
JL
Radivan
F
Patel
L
David
TJ
Home intravenous antibiotic therapy: practical aspects in children
J R Soc Med
 , 
1997
, vol. 
90
 (pg. 
26
-
33
)
161
Mullen
CA
Petropoulos
D
Roberts
WM
, et al.  . 
Economic and resource utilization analysis of outpatient management of fever and neutropenia in low-risk pediatric patients with cancer
J Pediatr Hematol Oncol
 , 
1999
, vol. 
21
 (pg. 
212
-
8
)
162
Mullen
CA
Petropoulos
D
Roberts
WM
, et al.  . 
Outpatient treatment of fever and neutropenia for low risk pediatric cancer patients
Cancer
 , 
1999
, vol. 
86
 (pg. 
126
-
34
)
163
Patrick
CC
Shenep
JL
Outpatient management of the febrile neutropenic child with cancer
Adv Pediatr Infect Dis
 , 
1999
, vol. 
14
 (pg. 
29
-
47
)
164
Petrilli
AS
Dantas
LS
Campos
MC
Tanaka
C
Ginani
VC
Seber
A
Oral ciprofloxacin vs. intravenous ceftriaxone administered in an outpatient setting for fever and neutropenia in low-risk pediatric oncology patients: randomized prospective trial
Med Pediatr Oncol
 , 
2000
, vol. 
34
 (pg. 
87
-
91
)
165
Porea
TJ
Margolin
JF
Chintagumpala
MM
Radiological case of the month: pulmonary air embolus with home antibiotic infusion
Arch Pediatr Adolesc Med
 , 
2001
, vol. 
155
 (pg. 
963
-
4
)
166
Sudela
K
Nursing aspects of pediatric home infusion therapy for the treatment of serious
Semin Pediatr Infect Dis
 , 
1990
, vol. 
1
 (pg. 
306
-
17
)
167
Wagner
CI
Wagstaff
P
Cox
TH
Annibale
DJ
Early discharge with home antibiotic therapy in the treatment of neonatal infection
J Perinatol
 , 
2000
, vol. 
20
 (pg. 
346
-
50
)
168
Wiernikowski
JT
Rothney
M
Dawson
S
Andrew
M
Evaluation of a home intravenous antibiotic program in pediatric oncology
Am J Pediatr Hematol Oncol
 , 
1991
, vol. 
13
 (pg. 
144
-
7
)
169
Hankins
J
Lonsway
RAW
Hedrick
C
Perdue
MD
Infusion therapy in clincial practice
 , 
2001
2d ed.
Philadelphia
W.B. Saunders
170
Kaushal
R
Bates
DW
Landrigan
C
, et al.  . 
Medication errors and adverse drug events in pediatric inpatients
JAMA
 , 
2001
, vol. 
285
 (pg. 
2114
-
20
)
171
Leff
B
Burton
JR
The future history of home care and physician house calls in the United States
J Gerontol A Biol Sci Med Sci
 , 
2001
, vol. 
56
 (pg. 
603
-
8
)
172
Baumgartner
JD
Glauser
MP
Single daily dose treatment of severe refractory infections with ceftriaxone: cost savings and possible parenteral outpatient treatment
Arch Intern Med
 , 
1983
, vol. 
143
 (pg. 
1868
-
73
)
173
Tice
AD
Seibold
G
Martinelli
LP
OPAT outcomes registry evaluaton of diabetic extremity infections [abstract 291]
Program and abstracts of the 41st Annual Meeting of the Infectious Diseases Society of America (IDSA) (San Diego, CA)
 , 
2003
Alexandria, VA
IDSA
174
Dalovisio
JR
Juneau
J
Baumgarten
K
Kateiva
J
Financial impact of a home intravenous antibiotic program on a medicare managed care program
Clin Infect Dis
 , 
2000
, vol. 
30
 (pg. 
639
-
42
)
175
Eron
LJ
Park
CH
Hixon
DL
Goldenberg
RI
Poretz
DM
Ceftriaxone therapy of bone and soft tissue infections in hospital and outpatient settings
Antimicrob Agents Chemother
 , 
1983
, vol. 
23
 (pg. 
731
-
7
)
176
Eron
LJ
Parenteral antibiotic therapy in outpatients: quality assurance and other issues in a protohospital
Chemotherapy
 , 
1991
, vol. 
37
 
Suppl 2
(pg. 
14
-
20
)
177
Eron
LJ
Passos
S
Early discharge of infected patients through appropriate antibiotic use
Arch Intern Med
 , 
2001
, vol. 
161
 (pg. 
61
-
5
)
178
Graninger
W
Wenisch
C
Wiesenger
E
Menschik
M
Karimi
J
Presterl
E
Experience with outpatient intravenous teicoplanin therapy for chronic osteomyelitis
Eur J Clin Microbiol Infect Dis
 , 
1995
, vol. 
14
 (pg. 
643
-
7
)
179
Green
SL
Practical guidelines for developing an office-based program for outpatient intravenous therapy
Rev Infect Dis
 , 
1991
, vol. 
13
 
Suppl 2
(pg. 
189
-
92
)
180
Grizzard
MB
Harris
G
Karns
H
Use of outpatient parenteral antibiotic therapy in a health maintenance organization
Rev Infect Dis
 , 
1991
, vol. 
13
 
Suppl 2
(pg. 
174
-
9
)
181
Harris
LF
Buckle
TF
Coffey
FL
Intravenous antibiotics at home
South Med J
 , 
1986
, vol. 
79
 (pg. 
193
-
6
)
182
Hindes
R
Winkler
C
Kane
P
Kunkel
MJ
Outpatient intravenous antibiotic therapy in Medicare patients: cost-savings analysis
Infect Dis Clin Pract
 , 
1995
, vol. 
4
 (pg. 
211
-
7
)
183
Leder
K
Turnidge
J
Grayson
ML
Home-based treatment of cellulitis with twice-daily cefazolin
Med J Aust
 , 
1998
, vol. 
169
 (pg. 
519
-
22
)
184
Morales
JO
Von Behren
L
Secondary bacterial infections in HIV-infected patients: an alternative ambulatory outpatient treatment utilizing intravenous cefotaxime
Am J Med
 , 
1994
, vol. 
97
 (pg. 
9
-
13
)
185
Nadworny
HA
Markowitz
A
Parenteral antibiotic therapy at home: experience with intramuscular cefonicid
Clinical Therapeutics
 , 
1987
, vol. 
10
 (pg. 
82
-
91
)
186
Nathwani
D
Moitra
S
Dunbar
J
Crosby
G
Peterkin
G
Davey
P
Skin and soft tissue infections: development of a collaborative management plan between community and hospital care
Int J Clin Pract
 , 
1998
, vol. 
52
 (pg. 
456
-
60
)
187
Nathwani
D
Morrison
J
Seaton
RA
France
AJ
Davey
P
Gray
K
Out-patient and home-parenteral antibiotic therapy (OHPAT): evaluation of the impact of one year's experience in Tayside
Health Bulletin
 , 
1999
, vol. 
57
 (pg. 
332
-
7
)
188
Nathwani
D
The management of skin and soft tissue infections: outpatient parenteral antibiotic therapy in the United Kingdom
Chemotherapy
 , 
2001
, vol. 
47
 (pg. 
17
-
23
)
189
Poretz
DM
The infusion center: a model for outpatient parenteral antibiotic therapy
Rev Infect Dis
 , 
1991
, vol. 
13
 
Suppl 2
(pg. 
142
-
6
)
190
Poretz
DM
Treatment of skin and soft-tissue infections utilizing an outpatient parenteral drug delivery device: a multicenter trial
Am J Med
 , 
1994
, vol. 
97
 (pg. 
23
-
7
)
191
Rehm
SJ
Graham
DR
Srinath
L
Prokocimer
P
Richard
MP
Talbot
GH
Successful administration of quinupristin/dalfopristin in the outpatient setting
J Antimicrob Chemother
 , 
2001
, vol. 
47
 (pg. 
639
-
45
)
192
Smego
RJ
Gainer
RB
Home intravenous antimicrobial therapy provided by a community hospital and a university hospital
Am J Hosp Pharm
 , 
1985
, vol. 
42
 (pg. 
2185
-
9
)
193
Steinmetz
D
Berkovits
E
Edelstein
H
Flatau
E
Almany
A
Raz
R
Home intravenous antibiotic therapy programme, 1999
J Infect
 , 
2001
, vol. 
42
 (pg. 
176
-
80
)
194
Stiver
HG
Telford
GO
Mossey
JM
, et al.  . 
Intravenous antibiotic therapy at home
Ann Intern Med
 , 
1978
, vol. 
89
 (pg. 
690
-
3
)
195
Wai
AO
Frighetto
L
Marra
CA
Chan
E
Jimenez-Ferreres
J
A cost analysis of an outpatient parenteral antibiotic program (OPAT): a Canadian teaching hospital and ministry of health perspective
Program and abstracts of the 37th Annual Meeting of the Infectious Diseases Society of America (IDSA) (Philadelphia) [abstract 537]
 , 
1999
Alexandria, VA
IDSA
pg. 
133
 
196
Williams
DN
Gibson
JA
Bosch
D
Home intravenous antibiotic therapy using a programmable infusion pump
Arch Intern Med
 , 
1989
, vol. 
149
 (pg. 
1157
-
60
)
197
Eron
LJ
Goldenberg
RI
Poretz
DM
Combined ceftriaxone and surgical therapy for osteomyelitis in hospital and outpatient settings
Am J Surg
 , 
1984
, vol. 
148
 (pg. 
1
-
4
)
198
Kunkel
MJ
Iannini
PB
Cefonicid in a once-daily regimen for treatment of osteomyelitis in an ambulatory setting
Rev Infect Dis
 , 
1984
, vol. 
6
 (pg. 
865
-
9
)
199
Maraqa
N
Gomez
MM
Rathore
MH
Alvarez
AM
Higher occurrence of hepatotoxicity and rash in patients treated with oxacillin, compared with those treated with nafcillin and other commonly used antimicrobials
Clin Infect Dis
 , 
2002
, vol. 
34
 (pg. 
50
-
4
)
200
Russo
TA
Cook
S
Gorbach
SL
Intramuscular ceftriaxone in home parenteral therapy
Antimicrob Agents Chemother
 , 
1988
, vol. 
32
 (pg. 
1439
-
40
)
201
Tice
AD
Osteomyelitis
Outpatient parenteral antimicrobial therapy: current status. Scientific American Medicine special report
 , 
1997
55
9
202
Tice
AD
Outpatient parenteral antimicrobial therapy for osteomyelitis
Infect Dis Clin North Am
 , 
1998
, vol. 
12
 (pg. 
903
-
19
)
203
Wagner
DK
Collier
BD
Rytel
MW
Long-term intravenous antibiotic therapy in chronic osteomyelitis
Arch Intern Med
 , 
1985
, vol. 
145
 (pg. 
1073
-
8
)
204
Wiselka
MJ
Nicholson
KG
Outpatient parenteral antimicrobial therapy: experience in a large teaching hospital
J Infect
 , 
1997
, vol. 
35
 (pg. 
73
-
6
)
205
Rehm
SJ
Tomford
JW
Longworth
DL
Keys
TF
McHenry
MC
Home intravenous antibiotic therapy (HIVAT) for endocarditis
Proceedings of the 30th Annual Meeting of the Infectius Diseases Society of America (IDSA) (Alexandria, VA) [abstract 18]
 , 
1992
Alexandria, VA
IDSA
206
Esposito
S
Treatment of lower respiratory tract infections in Italy: the role of outpatient parenteral antibiotic therapy
Chemotherapy
 , 
2001
, vol. 
47
 (pg. 
33
-
40
)
207
Gross
R
Graziani
AL
Laufer
D
Adverse effects of the use of intravenous pentamidine in the home
Infect Dis Clin Pract
 , 
1996
, vol. 
5
 (pg. 
456
-
8
)
208
Morales
JO
Snead
H
Efficacy and safety of intravenous cefotaxime for treating pneumonia in outpatients
Am J Med
 , 
1994
, vol. 
97
 (pg. 
28
-
33
)
209
Gilbert
J
Robinson
T
Littlewood
JM
Home intravenous antibiotic treatment in cystic fibrosis
Arch Dis Child
 , 
1988
, vol. 
63
 (pg. 
512
-
7
)
210
Hammond
LJ
Caldwell
S
Campbell
PW
Cystic fibrosis, intravenous antibiotics, and home therapy
J Pediatr Health Care
 , 
1991
, vol. 
5
 (pg. 
24
-
30
)
211
Kane
RE
Jennison
K
Wood
C
Black
PG
Herbst
JJ
Cost savings and economic considerations using home intravenous antibiotic therapy for cystic fibrosis patients
Pediatr Pulmonol
 , 
1988
, vol. 
4
 (pg. 
84
-
9
)
212
Pond
MN
Newport
M
Joanes
D
Conway
SP
Home versus hospital intravenous antibiotic therapy in the treatment of young adults with cystic fibrosis
Eur Respir J
 , 
1994
, vol. 
7
 (pg. 
1640
-
4
)
213
Trowbridge
JF
Outpatient parenteral antibiotic therapy. Management of serious infections. Part II: Amenable infections and models for delivery. Pneumonia and chronic lung disease
Hosp Pract (Off Ed)
 , 
1993
, vol. 
28
 (pg. 
16
-
20
)
214
van Aalderen
WM
Mannes
GP
Bosma
ES
Roorda
RJ
Heymans
HS
Home care in cystic fibrosis patients
Eur Respir J
 , 
1995
, vol. 
8
 (pg. 
172
-
5
)
215
Vinks
AA
Brimicombe
RW
Heijerman
HG
Bakker
W
Continuous infusion of ceftazidime in cystic fibrosis patients during home treatment: clinical outcome, microbiology and pharmacokinetics
J Antimicrob Chemother
 , 
1997
, vol. 
40
 (pg. 
125
-
33
)
216
Gross
ND
McInnes
RJ
Hwang
PH
Outpatient intravenous antibiotics for chronic rhinosinusitis
Laryngoscope
 , 
2002
, vol. 
112
 (pg. 
1758
-
61
)
217
Esposito
S
Noviello
S
Ianniello
F
D'errico
G
Ceftazidime for outpatient parenteral antibiotic therapy (OPAT) of chronic suppurative otitis media due to Psuedomonas aeruginosa
J Chemother
 , 
2000
, vol. 
12
 (pg. 
88
-
93
)
218
Niv
A
Nash
M
Pieser
J
Outpatient management of acute mastoiditis with periosteitis in children
Internat J Pediatr Otorhinolaryng
 , 
1998
, vol. 
46
 (pg. 
9
-
13
)
219
Colford
JMJ
Corelli
RL
Ganz
JW
Guglielmo
BJ
Jacobs
RA
Home antibiotic therapy for streptococcal endocarditis: a call for a controlled trial [letter]
Am J Med
 , 
1993
, vol. 
94
 (pg. 
111
-
2
)
220
Francioli
PB
Ceftriaxone and outpatient treatment of infective endocarditis
Infect Dis Clin North Am
 , 
1993
, vol. 
7
 (pg. 
97
-
115
)
221
Gentry
LO
Khoshdel
A
New approches to the diagnosis and treatment of infective endocarditis
Texas Heart Institute J
 , 
1989
, vol. 
16
 (pg. 
250
-
7
)
222
Huminer
D
Bishara
J
Pitlik
S
Home intravenous antibiotic therapy for patients with infective endocarditis
Eur J Clin Microbiol Infect Dis
 , 
1999
, vol. 
18
 (pg. 
330
-
4
)
223
Lopardo
G
Management of endocarditis: outpatient parenteral antibiotic treatment in Argentina
Chemotherapy
 , 
2001
, vol. 
47
 (pg. 
24
-
32
)
224
Rehm
SJ
Weinstein
AJ
Magilligan
D
Quinn
E
Endocarditis: medical and surgical management
Home management
 , 
1986
New York
Marcel Dekker
(pg. 
117
-
27
)
225
Stamboulian
D
Outpatient treatment of endocarditis in a clinic-based program in Argentina
Eur J Clin Microbiol Infect Dis
 , 
1995
, vol. 
14
 (pg. 
648
-
54
)
226
Miller
LK
Wing
DA
Paul
RH
Grimes
DA
Outpatient treatment of pyelonephritis in pregnancy: a randomized controlled trial
Obstet Gynecol
 , 
1995
, vol. 
86
 (pg. 
560
-
4
)
227
Bradley
JS
Farhat
C
Stamboulian
D
Branchini
OG
Debbag
R
Compogiannis
LS
Ceftriaxone therapy of bacterial meningitis: cerebrospinal fluid concentrations and bactericidal activity after intramuscular injection in children treated with dexamethasone
Pediatr Infect Dis J
 , 
1994
, vol. 
13
 (pg. 
724
-
8
)
228
Plotkin
SA
Treatment of bacterial meningitis
Pediatrics
 , 
1988
, vol. 
81
 (pg. 
904
-
7
)
229
Tice
AD
Strait
K
Ramey
R
Hoaglund
PA
Outpatient parenteral antimicrobial therapy for central nervous system infections
Clin Infect Dis
 , 
1999
, vol. 
29
 (pg. 
1394
-
9
)
230
Johansson
E
Bjorkholm
M
Wredling
R
Kalin
M
Engervall
P
Outpatient parenteral antibiotic therapy in patients with haematological malignancies: a pilot study of an early discharge strategy
Support Care Cancer
 , 
2001
, vol. 
9
 (pg. 
619
-
24
)
231
Kaplinsky
C
Drucker
M
Goshen
J
Tamary
H
Cohen
IJ
Zaizov
R
Ambulatory treatment with ceftriaxone in febrile neutropenic children
Isr J Med Sci
 , 
1994
, vol. 
30
 (pg. 
649
-
51
)
232
Mustafa
MM
Aquino
VM
Pappo
A
Tkaczewski
I
Buchanan
GR
A pilot study of outpatient management of febrile neutropenic children with cancer at low risk of bacteremia
J Pediatr
 , 
1996
, vol. 
128
 (pg. 
847
-
9
)
233
Sahu
S
Bapna
A
Pai
SK
Nair
CN
Kurkure
PA
Advani
SH
Outpatient antimicrobial protocol for febrile neutropenia: a nonrandomized prospective trial using ceftriaxone, amikacin, and oral adjuvant agents
Pediatr Hematol Oncol
 , 
1997
, vol. 
14
 (pg. 
205
-
11
)
234
Talcott
JA
Whalen
A
Clark
J
Rieker
PP
Finberg
R
Home antibiotic therapy for low-risk cancer patients with fever and neutropenia: a pilot study of 30 patients based on a validated prediction rule
J Clin Oncol
 , 
1994
, vol. 
12
 (pg. 
107
-
14
)
235
Tice
AD
Outpatient parenteral antibiotic therapy for fever and neutropenia
Infect Dis Clin North Am
 , 
1998
, vol. 
12
 (pg. 
963
-
77
)
236
Heley
A
Foscarnet infusion at home
Lancet
 , 
1988
, vol. 
2
 pg. 
1311
 
237
Wood
G
Whitby
M
Hogan
P
Frazer
I
Foscarnet infusion at home
Lancet
 , 
1989
, vol. 
1
 pg. 
156
 

Figures and Tables

Table A1.

Summary of reports that support the effectiveness outpatient parenteral antimicrobial therapy for various infectious conditions.

Table A1.

Summary of reports that support the effectiveness outpatient parenteral antimicrobial therapy for various infectious conditions.

These guidelines were developed and issued on behalf of the Infectious Diseases Society of America.

Comments

0 Comments