Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

New IDSA Guideline for Management of OPAT

Clin Infect Dis; ePub 2018 Nov 13; Norris, et al

The Infectious Diseases Society of America (IDSA) has issued an updated clinical practice guideline for the prescription and management of outpatient parental antimicrobial therapy (OPAT). Best practice tables that address pharmacokinetic features, administration options, and potential adverse effects of selected antimicrobials are included in the guideline. Recommendations are offered in the areas of: patient considerations, antimicrobial utilization, vascular access devices, monitoring, and antimicrobial stewardship. Among the included IDSA recommendations:

  • Patients (or their caregivers) should be allowed to self-administer OPAT.
  • In patients with no prior history of allergy to antimicrobials in the same class, the first dose of a new parenteral antimicrobial may be administered at home under the supervision of healthcare personnel who are qualified and equipped to respond to anaphylactic reactions.
  • In adult patients needing short courses of OPAT (less than 14 days), a midline catheter (MC) may be used rather than a central venous catheter. No recommendations can be made regarding the use of MCs in pediatric patients.
  • Serial laboratory testing should be monitored in patients receiving OPAT.
  • All patients should have infectious disease (ID) expert review prior to initiation of OPAT.


Norris AH, Shrestha NK, Allison GM, et al. 2018 IDSA clinical practice guideline for the management of outpatient parenteral antimicrobial therapy. [Published online ahead of print November 13, 2018]. Clin Infect Dis. doi:10.1093/cid/ciy745.