Outpatient Subcutaneous Antimicrobial Therapy (OSCAT) as a Measure to Improve the Quality and Efficiency of Healthcare Delivery for Patients With Serious Bacterial Infections.

Since the 1970s, outpatient parenteral antimicrobial therapy (OPAT) has been a viable option for patients who require intravenous antibiotics when hospitalization is not warranted. While the benefits of OPAT as a measure to improve the efficiency of healthcare delivery (i.e., reduced hospital days) and patient satisfaction are well-documented, OPAT is associated with a number of challenges, including line complications and reliance on daily healthcare interactions in some cases at home or in a clinic. To minimize the continued need for intensive healthcare services in the outpatient setting, there is trend toward patients self-administering antibiotics at home without the presence of healthcare workers, after adequate training. In most cases, patients administer the antibiotics through an established intravenous catheter. While this OPAT practice is becoming more accepted as a standard of care, the potential for line complications still exists. Outpatient subcutaneous antimicrobial therapy (OSCAT) has become an increasingly accepted alternative route of administration of antibiotics to IV by French infectious diseases physicians and geriatricians; however, currently, no antibiotics are approved to be administered subcutaneously. Antibiotics with longer half-lives that are completely absorbed and have a favorable local tolerability profile are ideal candidates for OSCAT and have the potential to maximize the quality and efficiency of parenteral antibiotic delivery in the outpatient setting. The increasing development of wearable, on-body subcutaneous delivery systems make OSCAT even more viable as they increase patient independence while avoiding line complications and potentially removing the need for direct healthcare professional observation.
Competing Interests: TF received speaker honorarium from scPharmaceuticals. TL served as a consultant for scPharmaceuticals. JG served as an advisory board member for scPharmaceuticals. VT received honoraria and research grants from scPharmaceuticals. JM was SVP of Clinical Development and Medical Affairs for scPharmaceuticals who was developing antibiotics for subcutaneous administration. CR-B received research grant from the French Health authorities (Agence Nationale de Sécurité du Médicament et des produits de santé, ANSM) and SG from the Foundation Innovations en Infectiologie (FINOVI) to perform a prospective study about the pharmacokinetic and safety of subcutaneous antimicrobial therapy in France (Pharmacocinétique et tolérance des antibiotiques administrés par voie sous-cutanée chez le patient âgé de plus de 65 ans; PHASAGE study). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2020 Ferry, Lodise, Gallagher, Forestier, Goutelle, Tam, Mohr and Roubaud-Baudron.)