Setting the Scene

试验中有证据表明（诗人&奥维瓦）在选定的患者组中，较早的骨骼和关节感染和心内膜炎中口服抗菌剂与长时间的静脉治疗一样有效。

In future, an increasing proportion of patients with serious infections are likely to be switched from IV to oral antimicrobials earlier in their clinical pathways. Or treated from the start using high dose, complex oral regimes that require a systematic approach to monitoring of both the antimicrobial regimen and clinical progress.

This shift has already begun with an increase in the use of intravenous (IV) antimicrobials and complex oral antimicrobial regimens within various outpatient or community-based clinical environments.

Infections managed by OPAT services are diverse, but include bloodstream, brain, bone & joint, cardiac, and renal tract infections, and many others. A fuller list can be seen这里.

这是在以下情况下发生的

• a rise in serious and/or resistant infections

• increasing recognition of the importance of discharging patients from hospital as soon as possible after clinical stability has occurred

• avoiding admission to hospital

在英国的研究中Dryden等，有8个住院的患者中有1个处方的全身性抗生素被认为适合通过持续的门诊治疗出院。作者认为，对于所有这些患者，必须使用某种形式的非一般从业人员，基于门诊病人的增强监测。

Oral antimicrobial regimens commonly prescribed and monitored by the Hull OPAT Service

不利影响

Oral antibiotics are common causes of drug-related adverse effects. In the USA, for example, sulfonamides, penicillins and quinolones are the most commonly implicated antibiotic classes in drug-related adverse effect presentations to emergency departments. Therefore, enhanced monitoring is required.

Perhaps the best example of an oral antibiotic that requires enhanced monitoring in the outpatient setting is Linezolid, which is 100% bioavailable via the oral route (if intact) resulting in therapeutic concentrations in many body tissues. It has activity against a wide-range of Gram-positive bacteria including those resistant to first-line antibiotics. It is therefore an attractive option when switching from IV to oral antibiotics, or for oral therapy from the start, when treating serious Gram-positive infections requiring an antibiotic with such characteristics.

Linezolid has potentially serious adverse effects (AEs), however, in particular, bone marrow suppression and, less frequently, neuropathy: mandating weekly enhanced monitoring for prolonged therapy.

Likewise, some oral Gram-negative agents, such as Chloramphenicol and Co-trimoxazole, also require monitoring – the exact requirements of which are sometimes dependent upon the nature of the patient being treated (i.e. comorbidity and medications) and the antimicrobial regimen prescribed.

本课程考虑了门诊环境中实践的两个方面：

1）在OPAT疗程结束时从IV转换为口服抗生素。

2) Monitoring complex oral antibiotic regimens within an OPAT service (increasingly referred to as complex oral and parenteral antibiotic therapy or COPAT).

安德鲁·西顿（Andrew Seaton）和马克·吉尔克里斯特（Mark GilchristOPAT.

您可能还会在免费的BSAC电子书中找到一些章节抗菌管理 - 从原则到实践useful too.