Developments in outpatient parenteral antimicrobial therapy (OPAT) for Gram-positive infections in Europe, and the potential impact of daptomycin

Parenteral antimicrobial therapy is traditionally offered in the inpatient setting in many parts of the world. In the USA, the past three decades have seen an unprecedented increase in the delivery of these therapies in the non-inpatient setting, and outpatient parenteral antibiotic therapy (OPAT) is now an established standard of care in North America. However, the uptake of OPAT within Europe has been more gradual, owing to a number of clinical, fiscal, logistical and cultural considerations. In particular, physicians who are not currently engaged in OPAT programmes frequently cite concerns over patient safety as a major barrier. However, where OPAT programmes have been established, high levels of satisfaction are reported by both patients and physicians, suggesting that many anxieties concerning the introduction of OPAT stem from a lack of patient and physician education regarding the key potential benefits associated with OPAT. As the burden of serious Gram-positive infections grows, so does the need to offer clinicians, administrators and patients alternative treatment programmes that are equally effective and safe compared with inpatient treatment, while promoting optimal use of limited healthcare resources. This article will review the European experience of OPAT, discussing the associated benefits and the potential antibiotic options, with an emphasis on the evolving experience with daptomycin.