Outpatient Parenteral Antibacterial Therapy of Serious Infections: The Role of Ceftriaxone
Julia A. Barman Balfour
Harriet M. Lamb
Outpatient parenteral antibacterial therapy (OPAT) is an increasingly popular means of containing the costs of antibacterial therapy, by avoiding the need for hospitalisation or allowing early discharge from hospital, in patients with serious infections. It also offers increased comfort and convenience to the patient, with less disruption of daily activities than inhospital treatment. Almost any type of infection can be considered for OPAT, but careful selection of patients is vital to the success of treatment. The third generation cephalosporins are popular antibacterial agents for use in OPAT programmes, because of their broad spectrum of antibacterial activity and good tolerability. Ceftriaxone is the most commonly used agent, as it has an elimination half-life of approximately 6 to 9 hours and can be given once daily. Moreover, it can be given by the intramuscular route. Ceftriaxone has been used successfully to treat bone and joint, skin and soft tissue and respiratory tract infections, nonenterococcal endocarditis and low risk febrile neutropenic episodes in outpatient settings (selected patients received all or part of their antibacterial therapy at home or at an outpatient centre). Over 80% of patients in most studies were clinically cured or improved. This approach was shown to reduce the number of days of hospitalisation required, with resultant cost savings. Conclusions: Ceftriaxone has a number of features which make it suitable for use in OPAT programmes. Clinical trials have demonstrated efficacy and cost savings using ceftriaxone in OPAT programmes in a range of serious infections.
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