What is it about?

Children with serious bacterial infections (SBIs) need to be treated with parenteral (e.g., intravenous) antimicrobial therapy. Usually this is done in hospital but some children may be treated as outpatients. Paediatric outpatient parenteral antimicrobial therapy (OPAT) has been used for some children since the 1970s and individual studies have reported that it is safe and effective. However, there has been little attempt to systematically consider these studies as a whole. The purpose of this review was to scope the published research literature to identify what is known about delivery, settings and outcomes of paediatric OPAT and to identify key knowledge deficits. We used an established framework to undertake structured review. Primary research studies were included if samples comprised children and young people 21 or under, who had received OPAT at home or in a day treatment centre. We used a quality appraisal tool to assess the quality of the studies to decide which ones we included in the review. From a preliminary pool of 157 articles, 51 papers were selected for full review. 19 studies fitted the inclusion criteria. Factors influencing delivery of OPAT were diverse and included child’s condition, home environment, child-related factors, parental compliance, training and monitoring. There was little consensus about what constituted the success of or adverse events in OPAT.

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Why is it important?

This study identifies the importance of clearly defining and using success indicators and adverse events to ensure that high quality evidence exists about the safety and effectiveness of paediatric OPAT. Further, outcomes that include child and parent perspectives need to be developed to allow a clearer appreciation of a successful paediatric OPAT service

Perspectives

Although there is generally consensus that paediatric OPAT is safe and effective, this study raises questions about this evidence base. Comparisons between the outcomes of different studies is difficult as the baseline indicators of success used are so diverse. Many studies do not report adverse events or do not report outcomes which could be viewed as adverse within this category.

Bernie Carter
Edge Hill University

Read the Original

This page is a summary of: Delivery, setting and outcomes of paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT): a scoping review, BMJ Open, November 2018, BMJ, DOI: 10.1136/bmjopen-2018-021603.
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