Outpatient Parenteral Antimicrobial Therapy in Children

  • Sanjay PatelEmail author
  • Helen Green
Pediatric Infectious Diseases (I Brook, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pediatric Infectious Diseases


Purpose of Review

Over recent years, there has been a marked increase in the number of centres delivering paediatric outpatient parenteral antimicrobial therapy (pOPAT). Various factors have fuelled this drive, including the significant economic pressures faced by high-income countries to contain the cost of healthcare, resulting in a significant reduction of in-patient beds over the past 20 years. It is essential that pOPAT services have formal clinical governance structures in place to ensure the safe and effective management of children being ambulated on intravenous antibiotics. They also require oversight of antimicrobial decisions by a medically qualified infection specialist to ensure that the principles of antimicrobial stewardship are adhered to. This review aims to provide an evidence-based framework for delivering pOPAT services.

Recent Findings

There is increasing data supporting the implementation of admission avoidance strategies for children with cellulitis and pyelonephritis. In addition, recent data supports the management of a subset of children with febrile neutropenia within pOPAT services. Above all, there is a clear recognition that embedding antimicrobial stewardship within pOPAT services reduces duration of intravenous antibiotics (IVAbs) and improves patient management.


pOPAT services are safe, cost-effective and associated with high levels of parent/patient satisfaction. Further research is required to develop risk prediction models for children being considered for pOPAT. Further data about the use of elastomeric devices in children and the acceptability of parental administration of IVAbs are also required.


Outpatient parenteral antimicrobial therapy Antimicrobial stewardship Antibiotic stewardship pOPAT Hospital at home Ambulatory antibiotics Children Paediatrics 


Compliance with Ethical Standards

Conflict of Interest

Sanjay Patel and Helen Green declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Paediatric Infectious Diseases & Immunology, Southampton Children’s HospitalUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
  2. 2.NIHR Biomedical Research CentreUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
  3. 3.NIHR Wellcome Trust Clinical Research FacilityUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK

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