Selection and training of patients for outpatient intravenous antibiotic therapy.

Outpatient intravenous antibiotic therapy (OPIVAT) requires selection of patients who are medically and psychologically stable, are capable of being trained to administer iv medications, will not abuse the iv system, and have insurance coverage. Patients with conditions such as osteomyelitis, septic arthritis, pelvic inflammatory disease, endocarditis, and skin and soft tissue infections are appropriate candidates. As clinical experience grows, patients with increasingly complex conditions are being successfully treated at home. Before OPIVAT can be utilized, mode of iv access, length of therapy, antibiotic selection, laboratory tests, and physician of record must be determined. Patients must be instructed how to handle emergencies. With appropriate training, such patients learn to properly manage drugs and equipment and to recognize complications. Patients who cannot be treated at home may be candidates for OPIVAT under direct medical supervision. Technical advances in pumps and catheters--as well as future changes in Medicare reimbursement--may greatly increase the number of patients who are capable of receiving OPIVAT.