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Safety and efficacy of outpatient parenteral antimicrobial therapy: A systematic review and meta-analysis of randomized clinical trials.
- Source :
-
International journal of antimicrobial agents [Int J Antimicrob Agents] 2024 Aug; Vol. 64 (2), pp. 107263. Date of Electronic Publication: 2024 Jul 02. - Publication Year :
- 2024
-
Abstract
- Background: Outpatient parenteral antimicrobial therapy (OPAT) offers an alternative to inpatient (hospital bed-based) treatment of infections that require intravenous administration of antimicrobials. This meta-analysis aimed to summarise the evidence available from randomised controlled trials (RCTs) regarding the efficacy and safety of OPAT compared to inpatient parenteral antimicrobial therapy.<br />Methods: We searched the Cochrane Library, MEDLINE, Embase, PubMed, and Web of Sciences databases for RCTs comparing outpatient versus inpatient parenteral antimicrobial therapy. We included studies without restrictions on language or publication year. Eligibility was reviewed independently by two assessors, and data extraction was cross validated. We evaluated bias risk via the Cochrane tool and determined the evidence certainty using GRADE. Meta-analysis was conducted using a random effects model. The protocol of this review was registered on PROSPERO (CRD42023460389).<br />Result: Thirteen RCTs, involving 1,310 participants were included. We found no difference in mortality (Risk Ratio [RR] 0.54, 95% Confidence Interval [CI] 0.23 to 1.26; P = 0.93), treatment failure (RR 1.0, CI 0.59 to 1.72; P = 0.99), adverse reaction related to antimicrobials (RR 0.89, CI 0.69 to 1.15; P = 0.38), and administration device (RR 0.58, CI 0.17 to 1.98; P = 0.87) between outpatient and inpatient parenteral antimicrobial therapy. The overall body of evidence had a low level of certainty.<br />Conclusion: Existing evidence suggests OPAT is a safe and effective alternative to inpatient treatment. Further RCTs are warranted for a thorough comparison of inpatient and outpatient parenteral antimicrobial therapy with a high level of certainty.<br /> (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
- Subjects :
- Humans
Treatment Outcome
Anti-Infective Agents therapeutic use
Anti-Infective Agents administration & dosage
Anti-Infective Agents adverse effects
Administration, Intravenous
Infusions, Parenteral
Anti-Bacterial Agents administration & dosage
Anti-Bacterial Agents therapeutic use
Anti-Bacterial Agents adverse effects
Randomized Controlled Trials as Topic
Ambulatory Care
Outpatients
Subjects
Details
- Language :
- English
- ISSN :
- 1872-7913
- Volume :
- 64
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- International journal of antimicrobial agents
- Publication Type :
- Academic Journal
- Accession number :
- 38960209
- Full Text :
- https://doi.org/10.1016/j.ijantimicag.2024.107263