Rapid Clinical Updates: Striving for Oral Stepdown: Novel Agents and Strategies for Avoiding OPAT-Handout

Handout

Pdf Summary

This clinical update from the Society of Hospital Medicine reviews novel agents and strategies to avoid outpatient parenteral antibiotic therapy (OPAT), traditionally used for severe infections but associated with complications. Newer approaches focus on using long-acting infusion antibiotics and oral stepdown therapy to reduce OPAT-associated risks in carefully selected patients. Success depends on treating infections caused by susceptible isolates rather than resistant ones, as per the "90/60 rule" indicating 90% treatment success with susceptible pathogens versus 60% with resistant.<br /><br />The DOTS trial evaluated dalbavancin, a long-acting antibiotic, for treating methicillin-resistant Staphylococcus aureus (MRSA) bacteremia—a major cause of morbidity and mortality. Dalbavancin showed non-inferiority to standard treatments like vancomycin and linezolid in efficacy, with similar adverse event profiles, offering a potential outpatient-friendly alternative.<br /><br />Oritavancin is another long-acting intravenous antibiotic effective against MRSA, comparable to vancomycin but with fewer adverse events. Its single-dose regimen makes it especially suitable for outpatient therapy of skin and soft tissue infections, reducing hospital admission rates within 30 days post-treatment.<br /><br />In summary, integrating novel agents like dalbavancin and oritavancin with oral stepdown strategies can help safely curtail the need for prolonged OPAT by enabling effective outpatient management in selected patients. Careful patient selection, avoiding resistant isolates, and balancing drug-related factors remain essential to optimize outcomes and minimize treatment complications. These developments represent a significant shift toward more convenient, patient-centered infection management without compromising efficacy or safety.

Keywords

Outpatient Parenteral Antibiotic Therapy

OPAT

Dalbavancin

Oritavancin

Methicillin-Resistant Staphylococcus aureus

MRSA

Long-Acting Antibiotics

Oral Stepdown Therapy

90/60 Rule

Skin and Soft Tissue Infections