Complex Outpatient Antimicrobial Therapy: Alternative Management Strategies and Outcomes.

Purpose of Review: Outpatient parenteral antibiotic therapy (OPAT) faces challenges requiring alternative solutions to long-term OPAT and skilled nursing facility (SNF) placement, particularly in persons who inject drugs (PWID). Recent Findings: SNF placement for antibiotic therapy is not ideal due to high rates of iatrogenic infections, social and financial burden, and poor outcomes for PWID. Hospital-at-home helps decrease length of stay and improves patient satisfaction. In many cases, IV-to-oral antibiotic transitioning and long-acting lipoglycopeptide agents are non-inferior to intravenous antibiotics, allowing for earlier discharge and avoidance of central-line placement. Summary: Alternatives to OPAT are beneficial for PWID and likely other vulnerable populations and in many cases should be the standard of care. This paper encourages program development and implementation for hospital at home selection, oral over IV antibiotics, and lipoglycopeptides for those who would benefit from their outpatient utility. [ABSTRACT FROM AUTHOR]