Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Dec 20, 2025; 15(4): 102894
Published online Dec 20, 2025. doi: 10.5662/wjm.v15.i4.102894
Effectiveness, safety, and feasibility of outpatient parenteral antimicrobial therapy in a resource-limited setting: A pilot longitudinal study
Amit Kumar, Prasan Kumar Panda
Amit Kumar, Prasan Kumar Panda, Department of Medicine, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
Author contributions: Kumar A contributed to the data collection and data analysis and was involved in manuscript writing; Panda PK provided the concept, interpreted the analysis, critically reviewed the draft, and approved it for publication along with Kumar A.
Institutional review board statement: The study was reviewed and approved by Institutional Ethics Committee, AIIMS Rishikesh, ensuring patient confidentiality, data protection, and adherence to ethical standards in research involving human participants.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We declare that we have no conflicts of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: It will be made available to others upon request to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Prasan Kumar Panda, MD, Professor, Department of Medicine, All India Institute of Medical Sciences, College Block, Rishikesh 249203, Uttarakhand, India. motherprasanna@rediffmail.com
Received: November 1, 2024
Revised: March 13, 2025
Accepted: April 3, 2025
Published online: December 20, 2025
Processing time: 276 Days and 17.7 Hours
Abstract
BACKGROUND

Outpatient parenteral antimicrobial therapy (OPAT) offers a crucial method for administering intravenous/intramuscular antimicrobials outside of hospital settings, allowing patients to complete treatment safely while avoiding many hospital-acquired complications. This is a major boost or low-hanging fruit intervention in antimicrobial stewardship practices with multiple targets like decreasing hospital stays, its related complications, the economy, the burden on hospitals, etc. However, resource-constrained countries like India practices rarely OPAT in an evidence-based way.

AIM

To evaluate the effectiveness, safety, and feasibility along with barriers and facilitators of OPAT practices in resource-poor settings, with a focus on its role in antimicrobial stewardship.

METHODS

This pilot longitudinal observational study included patients who met OPAT checklist criteria and were committed to post-discharge follow-up. Pre-discharge education and counselling were provided, and demographic data were recorded. Various outcome measures, including barriers and facilitators, were identified through an extensive literature review, fishbone diagram preparation, data collection and analysis, and patient feedback. All healthcare workers who were taking care of the patients discharged with OPAT were contacted with open-ended questions to get data on feasibility. The study was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences, Rishikesh. We used descriptive analysis and the χ2 test to analyze data. P value < 0.05 was considered significant.

RESULTS

Out of 20 patients, the mean age was 37 years. The cohort comprised 13 males. OPAT was administered at home in 15 cases and at nursing homes in 5 cases, with nine patients receiving treatment from family members and 11 patients receiving care from a local nurse. The infections requiring OPAT included: Kidney-urinary tract (6 cases), gastrointestinal tract (4 cases), respiratory tract (4 cases), meningitis (3 cases), endocarditis (2 cases), and multiple visceral abscesses (1 case). Nineteen out of 20 patients achieved afebrile status. Half of the patients did not receive education, counselling, or demonstrations prior to discharge, but all patients rated the service as good/excellent. According to doctors’ feedback, OPAT is highly beneficial and effective for patients when systematically implemented with daily telephonic monitoring, but faces challenges due to the lack of standardized protocols, dedicated teams, and adequate resources. The implementation of OPAT resulted in a reduction of hospitalization duration by an average of two weeks.

CONCLUSION

This pilot study proves that OPAT is safe, feasible, and efficacious by reducing two weeks of hospitalization in resource-poor settings. OPAT contributes directly to antimicrobial stewardship by reducing hospital stays and hospital-acquired complications, which is vital in combating antimicrobial resistance (AMR) and aligns with the global action plan for AMR in infection prevention and optimal antimicrobial utilization.

Keywords: Antimicrobial resistance; Barriers and facilitators; Integrated antimicrobial stewardship; Outpatient parenteral antimicrobial therapy; Telephonic monitoring

Core Tip: There is a lack of knowledge about the outpatient parenteral antimicrobial therapy (OPAT) practice among healthcare workers (HCWs), including those working in tertiary care settings. To improve the quality of OPAT practice, systematic implementation of standardized protocols, dedicated teams, and comprehensive pre-discharge education for patients and caregivers is essential. Enhancing these elements can further bolster antimicrobial stewardship and contribute to global efforts against antimicrobial resistance. This can be done by organizing training sessions for all HCWs involved in patient care.