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Issues to consider

Issues to consider
Black and white image of a stair case
© “stair case at the museum of contemporary art in chicago” flickr photo by David Hilowitz shared under a Creative Commons (BY) license
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.

This article is from the free online

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

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