Abstract
Outpatient parenteral antimicrobial therapy (OPAThttp) programs have become an important healthcare tool around the world. Portable elastomeric infusion pumps are functional devices for ambulatory delivery of antimicrobial drugs, and their stability is an essential point to guarantee an appropriate infusion administration. We conducted a systematic review to provide a synthesis and a critical evaluation of the current evidence regarding antimicrobial stability in elastomeric pumps. Data sources were PubMed, EMBASE, and Web of Sciences. The review protocol was registered on the Center for Open Science, and it was carried out following the PRISMA guidelines. Studies were eligible if the aim was the evaluation of the physicochemical stability of an antimicrobial agent stored in an elastomeric device. Of the 613 papers identified, 33 met the inclusion criteria. The most studied group of antimicrobials was penicillins, followed by cephalosporins and carbapenems. In general, the stability results of the antimicrobials that have been studied in more than one article agree with each other, with the exception of ampicillin, flucloxacillin, and ceftazidime. The antibiotics that displayed a longer stability were glycopeptides and clindamycin. Regarding the stability of antifungals and antivirals, only caspofungin, voriconazole, and ganciclovir have been investigated. The information provided in this article should be considered in patient treatments within the OPAT setting. Further stability studies are needed to confirm the appropriate use of the antimicrobials included in this program to ensure optimal patient outcomes.
Highlights
Over the last several decades, outpatient parenteral antimicrobial therapy (OPAT)programs have been implemented as a useful healthcare tool worldwide
Thirty papers were excluded because eleven papers were published in a conference abstract format, seven were not contained in an elastomeric device, two measured the stability within blood samples, and ten did not evaluate the physicochemical stability of the antimicrobial
Considering that elastomeric devices have shown their great utility in OPAT [47], this systematic review provides a comprehensive overview of antimicrobial stability, both physical and chemical, in elastomeric pumps
Summary
Programs have been implemented as a useful healthcare tool worldwide. These programs enable clinically stable patients to receive optimal antimicrobial treatment after hospital discharge [1]. OPAT programs provide several advantages, such as the improvement of the quality of life of patients, allowing them to continue with their daily routine at home despite receiving intravenous antibiotics. They reduce the potential risk of acquiring nosocomial infections or hospital-acquired delirium in elderly patients, and they decrease the mean number of hospitalization days, which is beneficial for the healthcare system [3]. Current OPAT models have some limitations, including the potential administration-related toxicity and the requirement of a healthcare professional in order to set up the pumps [4], especially if the administration is carried out at the outpatient facility
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