Patient selection criteria and management guidelines for outpatient parenteral antibiotic therapy for native valve infective endocarditis

Outpatient parenteral antibiotic therapy (OPAT) for infective endocarditis (IE) is being applied widely, despite the absence of controlled data that d emonstrates that outcomes are equivalent to those with standard inpatient a ntibiotic therapy. We review existing OPAT guidelines, published data on th e timing of complications from IE, and data on risk factors that can be use d to predict complications. These data are used to propose more stringent c riteria for patient selection and clinical management of OPAT for native va lve IE. We recommend a conservative approach (inpatient or daily outpatient follow-up) during the critical phase (weeks 0-2 of treatment), when compli cations are most likely, and we recommend consideration of OPAT for the con tinuation phase (weeks 2-4 or 2-6 of treatment) when life-threatening compl ications are less likely.