International Approaches to Treating Intravenous Drug Users in Outpatient Parenteral Antibiotic Services

Introduction The use of outpatient parenteral antibiotic therapy (OPAT) in intravenous drug–using (IVDU) patients remains controversial. It is currently unknown what the approaches and outcomes are of treating IVDU patients in OPAT services from around the world. We conducted an international survey to gain a better understanding of this issue. Methods A survey was conducted using an online survey program from May to October 2010 to OPAT centers from around the world. This survey addressed a range of issues including the following: the approach of health institutions on the treatment of IVDU patients requiring prolonged parenteral antibiotics, the outcomes of IVDU patients treated with OPAT, and the providers’ concerns and views on this form of therapy. The results were collated as a whole and also divided into geographical groups to compare responses internationally. Results Sixty-four OPAT centers from Australia, New Zealand, Asia, North America, United Kingdom, and Europe participated in this survey. Most of the responding centers (84.4%) stated they treat patients with a history of IVDU, and a significant proportion (44.2%) use peripherally inserted central catheters. Despite some concerns, most responders (84%) believe that the use of OPAT in IVDU patients is beneficial and outweighs the risks with little interregional variation in this approach and opinion. Conclusions Despite some limitations to survey distribution, we feel that these findings are important and unique. They show that, around the world, OPAT centers are treating IVDU patients with acceptable outcomes. Moreover, this form of therapy is increasingly regarded as a beneficial and a preferred treatment option in this significant group of patients.