Outpatient parenteral antimicrobial therapy (OPAT) guidelines: A systematic review
4 affiliations
- 1Institute for Clinical Research, National Institutes of Health, Shah Alam, Malaysia; Corresponding author at: Institute for Clinical Research, National Institutes of Health, No. 1, Jalan Setia Murni U13/52, 40170 Shah Alam, Selangor, Malaysia.
- 2Institute for Clinical Research, National Institutes of Health, Shah Alam, Malaysia
- 3Pharmacy Department, Hospital Selayang, Ministry of Health, Batu Caves, Malaysia
- 4Medical Department, Hospital Sungai Buloh, Ministry of Health, Sungai Buloh, Malaysia
Abstract
Background: To guarantee the safe and effective provision of Outpatient Parenteral Antimicrobial Therapy (OPAT), appropriate practice guidelines are essential for offering the necessary recommendations. This study aimed to synthesise and appraise published OPAT clinical practice guidelines. Method: Bibliographic databases were systematically searched for OPAT guidelines from inception to 14 July 2026, complemented by hand-searching. All guidelines in English were included. Reporting and methodological quality were evaluated using the Reporting Items for Practice Guidelines in Healthcare (RIGHT) and AGREE II tools. Correlations between AGREE II and RIGHT domain scores were investigated using Spearman’s correlation. Inter-rater agreement was assessed using intraclass correlation coefficients estimated with a two-way random effects model. Results: Seven guidelines met the eligibility criteria. Almost all guidelines were published or revised within the last 10 years, with the earliest one released in 2004 and the most recent one published in 2026. Most guidelines aimed to standardise the delivery, safety, and effectiveness of OPAT in their respective healthcare settings. The average overall score for methodological quality of the guidelines from AGREE II was 81.0%, while the average overall reporting quality score of the guidelines using the RIGHT instrument was 61.6%. There was an overall positive correlation between AGREE II and RIGHT domain scores. Conclusions: The OPAT guidelines have substantial heterogeneity in methodological quality and reporting completeness. While clear clinical recommendations were noted, lack of evidence syntheses methods and quality assurance were identified. Robust and transparent OPAT guidelines are critical to ensure safe, sustainable, and equitable expansion of outpatient antimicrobial care worldwide.
Related
- Optimizing intravenous amoxicillin for outpatient parenteral antimicrobial therapy
- Development of a national outpatient parenteral antimicrobial therapy (OPAT) pathway for skin and soft tissue infections in Scotland
- A novel meropenem dosing strategy for Outpatient Parenteral Antimicrobial Therapy (OPAT): a pilot pharmacokinetic/pharmacodynamic study in non-critically ill patients
- Oral Iron Trial before Parenteral Iron Therapy for Outpatients: A Patient Survey
- Adjunctive Strategies to Enhance Antimicrobial Photodynamic Therapy in Oral Infections: A Systematic Review of Randomized Controlled Trials
BibTeX
@article{lim2026outpatient,
title = {{Outpatient parenteral antimicrobial therapy (OPAT) guidelines: A systematic review}},
author = {Audrey Huili Lim and Norazida Ab Rahman and Afra Nahdia Marizan Nor and Nor Arisah Misnan},
journal = {Journal of Global Antimicrobial Resistance},
year = {2026},
month = nov,
doi = {10.1016/j.jgar.2026.09.015},
url = {https://doi.org/10.1016/j.jgar.2026.09.015},
note = {CC BY},
}
RIS
TY - JOUR
TI - Outpatient parenteral antimicrobial therapy (OPAT) guidelines: A systematic review
AU - Audrey Huili Lim
AU - Norazida Ab Rahman
AU - Afra Nahdia Marizan Nor
AU - Nor Arisah Misnan
PY - 2026
DA - 2026/11/06
JO - Journal of Global Antimicrobial Resistance
DO - 10.1016/j.jgar.2026.09.015
UR - https://doi.org/10.1016/j.jgar.2026.09.015
AB - Background: To guarantee the safe and effective provision of Outpatient Parenteral Antimicrobial Therapy (OPAT), appropriate practice guidelines are essential for offering the necessary recommendations. This study aimed to synthesise and appraise published OPAT clinical practice guidelines. Method: Bibliographic databases were systematically searched for OPAT guidelines from inception to 14 July 2026, complemented by hand-searching. All guidelines in English were included. Reporting and methodological quality were evaluated using the Reporting Items for Practice Guidelines in Healthcare (RIGHT) and AGREE II tools. Correlations between AGREE II and RIGHT domain scores were investigated using Spearman’s correlation. Inter-rater agreement was assessed using intraclass correlation coefficients estimated with a two-way random effects model. Results: Seven guidelines met the eligibility criteria. Almost all guidelines were published or revised within the last 10 years, with the earliest one released in 2004 and the most recent one published in 2026. Most guidelines aimed to standardise the delivery, safety, and effectiveness of OPAT in their respective healthcare settings. The average overall score for methodological quality of the guidelines from AGREE II was 81.0%, while the average overall reporting quality score of the guidelines using the RIGHT instrument was 61.6%. There was an overall positive correlation between AGREE II and RIGHT domain scores. Conclusions: The OPAT guidelines have substantial heterogeneity in methodological quality and reporting completeness. While clear clinical recommendations were noted, lack of evidence syntheses methods and quality assurance were identified. Robust and transparent OPAT guidelines are critical to ensure safe, sustainable, and equitable expansion of outpatient antimicrobial care worldwide.
SN - 2213-7165
SN - 2213-7173
ER -