Experience with a physician-directed, clinic-based program for outpatient parenteral antibiotic therapy in the USA.

The experience with 538 patients who received outpatient parenteral antibiotic therapy (OPAT) in 1993 in a private institute in Tacoma, Washington, USA, is reviewed here. Clinical outcomes suggested a successful resolution of infection in 99% of cases. Bacteriological outcomes showed that eradication of the organism had occurred in 92% of patients by the end of therapy. The success of the program indicates that 91% of properly selected patients can be treated without adverse events. Antibiotics were changed in 45 (8%) instances, but only half of these changes were made because of an adverse event. The development of rash was the most frequent adverse event and resulted in hospitalization in only 1 instance. Hospitalization was necessary before the OPAT program was completed in 42 cases--20 of those were for surgery and 13 for medical reasons unrelated to the infection or antibiotic therapy. In 8 cases, patients were hospitalized because of failure of home care or inability to administer the antibiotics effectively. Three patients were taken off the program because of failure to comply. Patient satisfaction surveys suggested that 99% of patients were satisfied with the program. With careful patient selection and a well-developed program, OPAT can be safe, effective and beneficial to patients and can save costs in healthcare services.