Issues to consider

The situation presented in case 2 is relatively complex, but reflects the complexity of many COPAT patients managed locally and elsewhere in the UK.

The main issues to consider based on the story in step 1.12 are:

• Is her clinical improvement/stability adequate for switching from IV to oral antibiotics?

• Allergy status needs detailed clarification (i.e. intolerance versus true allergy).

• Although the infection is due to MSSA, there are a number of resistances to account for.

• Potential interactions between sodium valproate and antibiotic therapy.

• Potential interactions between epilepsy and antibiotic therapy.

• Potential interactions between antibiotics if combination antibiotic therapy is prescribed.

• The patient is of child-bearing age; the possibility of breast-feeding or pregnancy should be reviewed as well as the contraceptive implications of the antibiotic regimen prescribed.

• Obesity and antibiotic dosing.

• The need for ongoing monitoring of any oral regimen prescribed.

• Duration of antibiotic therapy.

• Patient is prescribed sodium valproate and is of child-bearing age.

• Deep venous thrombosis prophylaxis.

• Follow-up required (where, when and by whom).

• Alternative outpatient IV options (if locally available) such as self- or nurse-administration at home.

• Social – will childcare impact her management/recovery in any other way (e.g. physiotherapy)?

• Governance – Was the initial OPAT assessment adequate (i.e. missed identification of potential childcare issues).

Read the papers in see also below for more information about prescribing and duration of antimicrobial therapy.