View source for Outpatient Parenteral Antimicrobial Therapy (OPAT) (IDSA 2018)

{| class="wikitable sortable"
! rowspan="2" |Antiinfective
! rowspan="2" |Oral Bioavailability, %a
! rowspan="2" |Doses per dayb
! rowspan="2" |Infusion Time
! rowspan="2" |Delivery Devicec
! colspan="3" |Monitoring Frequency (Weekly)
! rowspan="2" |Most Common Potentially Serious ADRs
! rowspan="2" |Torsades de Pointes Riske
! rowspan="2" |Other Comments
|-
!CBC-diff
!BMP: including K, Cr, BUN
!Liver profile:
ALT, AST, ALK, Tbil
|-
! colspan="11" |Antibiotics
|-
|Amikacin 
|NA 
|1–3 
|30–60 min depending on dose 
|Grav, Elas 
|1 
|2 
|… 
|Nephrotoxicity; ototoxicity 
|
|See aminoglycoside monitoringf 
|-
|Ampicillin 
|50 
|4–6 
|3–5 min push or 10–15 min infusion 
|Grav, EID, IVP 
|1 
|1 
|1 
|Hypersensitivity including anaphylaxis 
|
|Stable once reconstituted for only 3 days; see stability footnoteg 
|-
|Ampicillin-sulbactam 
|NA 
|3–4 
|10–15 min push or 15–30 min infusion 
|Grav, EID, Elas, IVP 
|1 
|1 
|1 
|Hypersensitivity including anaphylaxis 
|
|Stable once reconstituted for only 3 days; see stability footnoteg 
|-
|Azithromycin 
|28–52 
|1 
|60 min 
|Grav 
|1 
|… 
|… 
|
|Known 
|Consider change to po 
|-
|Aztreonam 
|NA 
|2–4 
|3–5 min push or 20–60 min infusion 
|Grav, EID, Elas, IVP 
|1 
|1 
|1 
|
|
|Rare cross-allergenicity with other beta-lactams 
|-
|Cefazolin 
|NA 
|3–4 
|3–5 min push or 30–60 min infusion 
|Grav, Elas, IVP 
|1 
|1 
|… 
|Hypersensitivity including anaphylaxis 
|
|Dialysis-only dosing possible 
|-
|Cefepime 
|NA 
|2–3 
|5 min push or 30 min infusion 
|Grav, Elas, IVP 
|1 
|1 
|… 
|Hypersensitivity including anaphylaxis 
|
|Dialysis-only dosing possible 
|-
|Cefoxitin 
|NA 
|3–4 
|3–5 min push or 20–30 min infusion 
|Grav, Elas, IVP 
|1 
|1 
|… 
|Hypersensitivity including anaphylaxis 
|
|
|-
|Ceftaroline 
|NA 
|2–3 
|5 min push or
5–60 min 
|Grav, IVP 
|1 
|1 
|… 
|Hypersensitivity including anaphylaxis 
|
|
|-
|Ceftazidime 
|NA 
|3 
|3–5 min push or 15–30 min infusion 
|Grav, Elas, IVP 
|1 
|1 
|… 
|Hypersensitivity including anaphylaxis 
|NA 
|Dialysis-only dosing possible 
|-
|Ceftazidime-avibactam 
|NA 
|3 
|120 min 
|Grav, EID 
|1 
|1 
|… 
|Hypersensitivity including anaphylaxis 
|
|… 
|-
|Ceftolozane-tazobactam 
|NA 
|3 
|60 min 
|Grav, EID 
|1 
|1 
|… 
|Hypersensitivity including anaphylaxis 
|
|… 
|-
|Ceftriaxone 
|NA 
|1–2 
|1–4 min push or 30 min infusion 
|Grav, Elas, IVP 
|1 
|1 
|1 
|Hypersensitivity including anaphylaxis 
|
|See monitoring footnoted 
|-
|Ciprofloxacin 
|50–85 
|2–3 
|60 min 
|Grav, Elas 
|… 
|… 
|… 
|Tendonitis/tendon rupture; peripheral neuropathy 
|Known 
|Consider change to po; see monitoring footnoted 
|-
|Clindamycin 
|90 
|3–4 
|10–60 min (not to exceed 30 mg/min) 
|Grav, Elas 
|1 
|1 
|1 
|
|
|Consider change to po; see monitoring footnotef 
|-
|Colistin 
|NA 
|2–4 
|3–5 min IVP; 30 min for infusion 
|Grav, IVP 
|1 
|2 
|… 
|Nephro- and neurotoxicity 
|
|Inhaled colistin may be an option for respiratory tract infections 
|-
|Daptomycin 
|NA 
|1 
|2 min push or 30 min infusion 
|Grav, Elas, IVP 
|1 
|1 
|… 
|Myopathy; rhabdomyolysis 
|
|Baseline and weekly CK, discontinue if symptomatic and CK >1000 U/L (~5× ULN) or asymptomatic and CK >2000 U/L (~10× ULN);
dialysis-only dosing possible 
|-
|Dalbavancin 
|NA 
|Once per week 
|30 min 
|Grav 
|… 
|… 
|… 
|Hypersensitivity including anaphylaxis 
|
|Red man syndrome more likely if infusion <30 min; monitoring requirements unknown for treatment duration greater than 2 weeks 
|-
|Ertapenem 
|NA 
|1 
|30 min 
|Grav, Elas 
|1 
|1 
|1 
|Hypersensitivity including anaphylaxis 
|NA 
|See stability footnoteg 
|-
|Gentamicin 
|NA 
|1–3 
|30–120 min depending on dose 
|Grav, EID, Elas 
|1 
|2 
|… 
|Nephrotoxicity; ototoxicity 
|
|See aminoglycoside monitoringf 
|-
|Imipenem 
|NA 
|3–4 
|20–60 min depending on dose 
|Grav 
|1 
|1 
|1 
|Hypersensitivity including anaphylaxis; seizures 
|
|See stability footnoteg 
|-
|Levofloxacin 
|90 
|1 
|60–90 min depending on dose 
|Grav 
|… 
|… 
|… 
|Tendonitis/tendon rupture; cardiac arrhythmias; peripheral neuropathy 
|Known 
|Consider change to po; see monitoring footnote;d dialysis-only dosing possible 
|-
|Linezolid 
|100 
|2 
|30–120 min 
|Grav, EID 
|1 
|… 
|1 
|Thrombocytopenia; leukopenia; anemia;
peripheral neuropathy; optic neuritis 
|
|Consider change to po; monitor for neuropathy, optic neuritis in prolonged use; see monitoring footnote;d potential for drug interactions 
|-
|Meropenem 
|NA 
|3–4 
|30 min 
|Grav, Elas 
|1 
|1 
|1 
|Hypersensitivity including anaphylaxis 
|
|Dialysis-only dosing possible; see stability footnoteg 
|-
|Metronidazole 
|100 
|2–4 
|30–60 min 
|Grav, EID, Elas 
|1 
|… 
|… 
|Peripheral neuropathy 
|Conditional 
|Consider change to po 
|-
|Nafcillin 
|NA 
|4–6 
|30–60 min 
|Grav, EID 
|1 
|1 
|1 
|Hypersensitivity including anaphylaxis 
|
|Central line commonly used because of concern for phlebitis risk 
|-
|Oritavancin 
|NA 
|Once 
|180 min 
|Grav 
|… 
|… 
|… 
|Hypersensitivity including anaphylaxis; infusion related 
|
|Red man syndrome more likely if infusion <60 min; monitoring requirements unknown for treatment duration greater than a single dose 
|-
|Oxacillin 
|NA 
|4–6 
|10–30 min 
|Grav, Elas 
|1 
|1 
|1 
|Hypersensitivity including anaphylaxis; hepatotoxicity 
|
|Central line commonly used because of concern for phlebitis risk 
|-
|Penicillin G 
|25–73 
|4–6 
|15–30 min 
|Grav, EID 
|1 
|1 
|1 
|Hypersensitivity including anaphylaxis 
|
|Oral penicillin V K is not a substitute for IV treatment of most clinical conditions requiring IV penicillin, eg, syphilis 
|-
|Piperacillin-tazobactam 
|NA 
|3–4 
|30–240 min (extended infusion) 
|Grav, EID 
|1 
|1 
|1 
|Hypersensitivity including anaphylaxis 
|
|
|-
|Polymyxin B 
|NA 
|1 
|60–90 min 
|Grav 
|1 
|2 
|… 
|Nephro- and neurotoxicity 
|
|Monitor for nephrotoxicity, neurotoxicity 
|-
|Rifampin 
|70–90 
|1–3 
|30 min 
|Grav 
|1 
|1 
|1 
|Hepatitis; hypersensitivity 
|NA 
|Potential for drug–drug interactions; consider change to po 
|-
|Tedizolid 
|91 
|1 
|60 min 
|Grav 
|1 
|… 
|1 
|Thrombocytopenia; leukopenia; anemia; peripheral neuropathy; optic neuritis 
|
|Consider change to po; monitor for neuropathy, optic neuritis in prolonged use; potential for drug interactions; see monitoring footnoted 
|-
|Telavancin 
|NA 
|1 
|60 min 
|Grav 
|1 
|2 
|… 
|Nephrotoxicity; hypersensitivity including anaphylaxis; infusion-related prolongation of QTc 
|Possible 
|High rate of renal injury in patients aged >65 years, with preexisting renal impairment or other nephrotoxins; red man syndrome more likely if infusion <60 min 
|-
|Tigecycline 
|NA 
|2 
|30–60 min 
|Grav 
|1 
|1 
|1 
|Nausea/ vomiting 
|
|
|-
|Tobramycin 
|NA 
|1–3 
|30–120 min depending on dose 
|Grav, EID, Elas 
|1 
|2 
|… 
|Nephrotoxicity; ototoxicity 
|
|See aminoglycoside monitoringf 
|-
|Trimethoprim/ sulfamethoxazole 
|85 
|2–4 
|60–90 min 
|Grav 
|1 
|1 
|1 
|Hyperkalemia; rash; nephrotoxicity; Stevens Johnson syndrome 
|Special 
|Consider change to po; potential for drug–drug interactions; high fluid requirement; spurious increase in serum creatinine 
|-
|Vancomycin 
|NA 
|1–2 
|60–120 min depending on dose 
|Grav, EID, Elas 
|1 
|1 
|… 
|Nephrotoxicity; infusion-related reactions 
|
|Dialysis-only dosing possible; vancomycin trough levels or area under the curve/minimum inhibitory concentration weekly and with dose changes;
red man syndrome more likely if infusion <60 min 
|-
! colspan="11" |Antifungals
|-
|Amphotericin B 
|NA 
|1 
|Liposomal: 2 hours Deoxycholate: 2–4 hours 
|EID (including pole pump)
Elas 
|1 
|2 
|1 
|Rates >10%; hypotension, rigors, nausea, vomiting, diarrhea, anemia, thrombocytopenia,
electrolyte abnormalities (K, Mg, Ca), renal failure, hypoglycemia, LFT abnormalities 
|Conditional 
|Sodium loading recommended; chemistry 10 preferredf 
|-
|Anidulafungin 
|NA 
|1 
|1.5 hours 
|Grav 
|1 
|1 
|1 
|
|
|
|-
|Caspofungin 
|NA 
|1 
|1 hour 
|Grav, EID, Elas 
|1 
|1 
|1 
|
|
|
|-
|Fluconazole 
|≥90 
|1 
|1–2 hours (not to exceed 200 mg/h) 
|Grav, Elas 
|… 
|… 
|1 
|
|Known 
|Consider change to po; watch for drug-drug interactions 
|-
|Isavuconazole 
|98 
|1–3 
|≥1 hour 
|Grav (with pump) 
|… 
|… 
|1 
|
|
|Consider change to po; watch for drug–drug interactions 
|-
|Micafungin 
|NA 
|1 
|1 hour 
|Grav 
|1 
|1 
|1 
|
|
|
|-
|Posaconazole 
|Highly dependent on gastric pH 
|1–2 
|90 min with in-line filter 
|Grav 
|1 
|1 
|1 
|
|Conditional 
|Consider change to po; watch for drug–drug interactions 
|-
|Voriconazole 
|96 
|2 
|1–2 hours 
|Grav 
|1 
|1 
|1 
|Hallucinations; auditory/ visual disturbances; skin changes; fluorosis with prolonged use 
|Conditional 
|Consider change to po; watch for drug–drug interactions; monitor plasma concentrations; avoid intravenous formulations if CrCl <50 unless benefits clearly outweigh risks (accumulation of cyclodextrin vehicle) 
|-
! colspan="11" |Antivirals
|-
|Acyclovir 
|10–30 
|3 
|1 hour 
|Grav, Elas 
|1 
|1 
|… 
|Crystalluria; acute renal injury 
|
|Hydration critical in preventing nephrotoxicity;
consider change to po valacyclovir, famciclovir, or acyclovir 
|-
|Cidofovir 
|NA 
|1 
|1 hour 
|EID (including pole pump) 
|1 
|2 
|1 
|Rash; anemia; neutropenia; iritis; uveitis; decreased intraocular pressure; nephrotoxicity; metabolic acidosis 
|
|Hydrate with NS before and after dose; consider probenecid; urinalysis weekly; chemistry 10 preferredf 
|-
|Foscarnet 
|NA 
|1–3 
|1–2 hours (not to exceed 1 mg/kg/ min) 
|EID, Elas 
|1 
|2 
|1 
|Nephro- and neurotoxicity; anemia; granulocytopenia; electrolyte disturbances 
|
|Hydrate with NS or D5W prior to first dose; chemistry 10 preferredf 
|-
|Ganciclovir 
|5–10 
|1–2 
|1 hour 
|Grav, Elas 
|2 
|1 
|… 
|Dose-dependent myelosuppression 
|
|Consider change to po valganciclovir 
|}