Patient selection for ambulatory antimicrobial therapy

Careful patient selection for ambulatory antimicrobial therapy is crucial for positive clinical outcomes. Ambulatory antimicrobial therapy may be required for:

• a patient who has an infection that can only be treated with parenteral (usually intravenous) antimicrobials (see Parenteral route of administration for antimicrobials)
• a patient who has an infection that requires a complex oral regimen and close monitoring (eg a patient with a complex bone and joint infection who has had an early switch from intravenous to oral therapy will require monitoring for adverse effects and early signs of deterioration).

Selection criteria must include all of the following:

• the patient must be clinically and haemodynamically stable
• patient, carer or substitute decision-maker must understand the treatment and requirements of ambulatory antimicrobial therapy
• a documented antimicrobial treatment plan (eg dose, frequency, expected duration, plan for intravenous to oral switch) must be available
• if parenteral antimicrobials are required, an appropriate intravenous antimicrobial regimen amenable to administration in a community setting is available, and is consistent with the principles of appropriate antimicrobial prescribing
• the patient must be assessed initially by at least one member of the ambulatory antimicrobial therapy team, but ideally by a doctor, pharmacist and nurseChapman, 2019
• medical responsibility must be established and documented, and ongoing review arrangedChapman, 2019
• the home or other treatment environment must be suitable (eg has running water, light and heat, refrigeration and a working telephone) and safe for the patient and visiting staff.

Patients with drug or alcohol misuse problems should be assessed for suitability on a case-by-case basisNorris, 2019. Careful counselling about the hazards of vascular access manipulation is recommended.