Outpatient parenteral antimicrobial therapy (OPAT) for the treatment of osteomyelitis: evaluation of efficacy, tolerance and cost

Objectives: To evaluate the feasibility, efficacy, and cost of outpatient p arenteral antimicrobial therapy (OPAT) in the treatment of osteomyelitis. Subjects: 39 patients with an osteomyelitis requiring parenterally administ ered antibiotics for more than 4 weeks, and able to receive antibiotics at home. Methods: All patients had a totally implanted catheter. Antibiotics were ad ministered by continuous infusion using a portable elastomeric infusion sys tem, which was changed every day by the patient or by the home-care nurse. Laboratory monitoring and surveillance were performed weekly. Clinical effi cacy, adverse effects and quality of life were recorded. Results: The most commonly used antibiotics were vancomycin (51%) and beta -lactam (44%) antibiotics. Thirty patients were available for follow-up for a minimum of 12 months after completion of therapy. Twenty-eight (93%) wer e considered cured of their infection with a mean of 24 +/- 4 months after completion of antibiotic therapy. Adverse effects among the study patients were rare. The 39 patients in our OPAT programme resulted in a potential sa ving of US $1 873 885 relative to conventional therapy. Conclusion: OPAT is practicable and effective and may be the best alternati ve treatment for patients suffering from osteomyelitis requiring intravenou s therapy.