Paediatric OPAT perspective

Hi, my name is Sanjay Patel I’m a consultant in paediatric infectious diseases at Southampton Children’s Hospital and I lead the UK OPAT network for children. We set up the tertiary OPAT service at Southampton Children’s Hospital in about 2012 and in the past few years, we’ve worked with colleagues across the country to develop similar services in children’s hospitals in Liverpool, London, Bristol.

The impacts of tertiary OPAT has been huge. It’s meant that children who would have otherwise been managed in hospital for days or weeks are now receiving their care at home. As you know, all of our services are increasingly stretched in terms of beds, and it’s had a huge impact on our hospitals in terms of cost saving, the delivery of tertiary OPAT. The principles of delivering a paediatric OPAT service are almost identical to those of delivering OPAT to adults. Appropriate patient selection is paramount for delivering a safe OPAT service. The key is a robust multidisciplinary approach, and working closely with specialist nurses, pharmacists, microbiologists, and a CVAS service allows a safe OPAT service to be delivered.

That said, there are some differences between paediatric and adult OPAT. Vascular access is more challenging. Children requiring picc lines often need to go to theatre. The antibiotics we have available are more limited than available in adult practice and the structure in which we deliver OPAT is different between paediatrics and adults. Infectious diseases is delivered in most hospitals across the UK, but, for children, it’s often focused in children’s hospitals that serve a large geographical area and so our approach in the UK so far has been to focus tertiary OPAT in those children’s hospitals.

However, in the past few years, we have recognised that the majority of children on intravenous antibiotics require short courses of antibiotics, but still require the same robustness in terms of governance and antibiotic stewardship. And so our approach has been to augment our ambulatory OPAT services. And I think that has been extremely exciting because that approach can be rolled out to the DGHs across the UK in time. One of the challenges we have in paediatrics is the paucity of high-quality data on duration of antibiotic course and timing of intravenous to oral switches.

Our approach has been to work as a national network to look at individual pathologies and variation of practice and through this approach, we hope that we can standardise and optimise our approaches to antibiotic use. And once again, that reiterates the importance of antibiotic stewardship and embedding it within our OPAT services. Future developments in paediatric OPAT are going to be the extension from tertiary hospitals to DGHs. And although the service structure will differ, and the lack of infectious diseases teams in those hospitals will make that more challenging, maintaining that robust governance is something we need to ensure. Parents’ administration of OPAT is also likely to be something that we work on in the next few years within the paediatric OPAT initiative.

And another exciting development, which is being piloted in some hospitals, is neonatal OPAT. And this is likely to impact on children extremely early in life in terms of administering antibiotics at home. In conclusion, paediatric OPAT shares great similarities with adult OPAT in terms of the principles of safe delivery. However, there are some unique differences. And through collaboration with centres across the UK and internationally, we increasingly recognise how to safely deliver OPAT to children. Thank you.