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Issues to consider

Issues to consider
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© BSAC

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.

© BSAC
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Intravenous to Oral Switch: Within Outpatient Parenteral Antibiotic Therapy (IVOST)

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