Safety and efficacy of outpatient parenteral antimicrobial therapy: a systematic review and meta-analysis of randomized clinical trials
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.
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).
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.
CONCLUSION…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,310 participants or records.
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