Skip to 0 minutes and 7 secondsHi, I'm Fiona I'm the antimicrobial pharmacist for the OPAT service in Glasgow, and my role is really to ensure safe, effective, appropriate antibiotics for OPAT patients. When patients get referred to OPAT I think the most important thing is to find out what medicines they're prescribed to ensure that any antibiotic plans we want to instigate are not going to interact and they're not going to cause problems with what we want to achieve with the patient.

Skip to 0 minutes and 31 secondsSo just making sure there's no drug interactions, and also having the discussion about any drug-food interactions or any supplements they might be taking, including homoeopathic medicines and herbal medicines and things as well, really just to ensure that it's not going to cause issues with any plans we want to instigate. So sometimes we choose drugs within the antibiotic plan that require therapeutic drug monitoring just to ensure the ongoing safety of these drugs for patients. So in the hospital setting we might choose something like a glycopeptide for example, like vancomycin that's not really appropriate to use in the outpatient setting because we have to have multiple daily dosing. And we tend to change that to a drug called teicoplanin, another glycopeptide.

Skip to 1 minute and 11 secondsBut we use the advantage of a long half life to enable us to use either daily or three times a week dosing. But we still need to do levels to ensure that we're achieving a safe level in a patient that's effective as well for treating the infection. So it's important to individualise a dose, ensure that we can take levels at an appropriate time, and try and get those taken levels back in a timely manner, and try and interpret them for that individual patient. And the other drugs we do that for include amikacin. We might use that for microbacterial infections.

Skip to 1 minute and 47 secondsAnd again, using it and aminoglycocides, in an outpatient setting we have to ensure that we do levels to ensure its safety, but also we're getting effective levels. And I think that's a really important role to play, and it just shows that we're achieving safe, effective use of these drugs in an outpatient setting as we would equally in the hospital setting. So obviously, when we choose any antibiotic for the outpatient setting for parenteral antibiotics, it's desirable to give everything as a bolus, because that is quick and easy for the patient either when they're self-administering or to administer in the hospital.

Skip to 2 minutes and 24 secondsBut it has to be quick for the patient so we're not tying them to the hospital for long periods of time. Obviously that isn't achievable for all drugs, and some drugs have to be given as an infusion. And when we choose any drug with an infusion we again try to choose something that's got a short infusion, maybe up to a maximum of 30 minutes. But there are new devices out in the market, and through stability trials that we're doing at the moment that we can actually maybe use certain drugs and can administer them as continuous infusions over a 24-hour period.

Skip to 2 minutes and 54 secondsAnd that enables us to use drugs like flucloxacillin, which we haven't used before in an outpatient setting, because traditionally it's a four times a day dosing, which isn't really practical for outpatient use. But the continuous infusion pumps that are now becoming available does mean that we could use this drug maybe for things like Staph Aureus bacteremias, where it's a desirable first line option. And it gives us that opportunity to use it for these patients and take a different group of patients onto the OPAT service.

Skip to 3 minutes and 19 secondsBut we can also bring knowledge on by availability, distribution, metabolism, and how the drug is actually cleared from the body, so that we can build in any dose changes that we might require for evading renal impairment or liver impairment for that drug. I also think it's important just to also impact on any IVOST options. So if we have started to implement IV antibiotics, what would be the most appropriate oral antibiotics. And I think any choice of antibiotics we have for the OPAT guidelines, they have to mirror the same antimicrobial stewardship policies and prescribing that we have in the hospital because we're accountable for that in an outpatient setting too.

Specialist antimicrobial pharmacist

The specialist antimicrobial pharmacist (AMP) is a core member of the OPAT team being involved in patient screening and providing pharmaceutical care for those patients who enter the OPAT programme.

Within the team the AMP advises on antimicrobial choice and delivery device selection, dosing regimen advice, therapeutic drug monitoring and potential drug interactions. In some services antimicrobial pharmacists will be independent prescribers and may also have extended roles in clinical assessment.

In this video Fiona Robb explains her role.

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OPAT: Outpatient Parenteral Antimicrobial Therapy


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