title: Outpatient parenteral antimicrobial therapy with ceftriaxone, a review.
abstract: BACKGROUND
  More than 30 years since it was developed for clinical use, the third-generation cephalosporin ceftriaxone remains the most commonly used agent for outpatient parental antimicrobial therapy (OPAT). Recent antimicrobial stewardship programmes have tended to restrict ceftriaxone use in hospitals to control antibiotic resistance and outbreaks of Clostridium difficle infection (CDI). Considering the expansion of OPAT programmes both in the UK and worldwide, revisiting the role of ceftriaxone in OPAT in the context of changing antimicrobial prescribing practices is timely.
  
  
  OBJECTIVE
  To identify the evidence base for OPAT, review current and historical data on indications for, and safety of ceftriaxone within the OPAT setting, and to provide some perspectives on the future role of ceftriaxone.
  
  
  METHODS
  We searched PubMed and Scopus for articles published in English, and hand searched reference lists. We also conducted a complementary descriptive analysis of prospectively acquired data on the use of ceftriaxone in more than 1,300 OPAT episodes over a 10-year period in our UK centre.
  
  
  RESULTS
  Ceftriaxone has an excellent safety profile in the OPAT setting, and its broad spectrum of activity makes it an established agent in a wide range of clinical infection syndromes, such as skin and soft-tissue infection, bone and joint infection, streptococcal endocarditis and several others. Intriguingly, in contrast to the inpatient setting, liberal use of ceftriaxone in OPAT has not been strongly linked to CDI, suggesting additional patient and environmental factors may be important in mediating CDI risk.
authors.affiliation: Brownlee Centre for Infection, Tropical Medicine and Counselling, Gartnaval Hospital, Glasgow, G12 0YN, UK. chrisduncan@doctors.net.uk
authors.forename: Christopher J A
authors.initials: CJ
authors.lastname: Duncan
authors.forename: David A
authors.initials: DA
authors.lastname: Barr
authors.forename: R Andrew
authors.initials: RA
authors.lastname: Seaton
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002443:Ceftriaxone / Q000008:administration & dosage*; D003141:Communicable Diseases / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007263:Infusions, Parenteral / Q000379:methods*; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone