Routine lab monitoring for cefazolin, ceftriaxone in OPAT may be ‘excessive’
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Key takeaways:
- Few adverse events were reported in OPAT containing cefazolin and ceftriaxone.
- Only 2.7 clinically significant OPAT adverse events were identified per 1,000 sets of weekly labs.
Few adverse events following outpatient parenteral antimicrobial therapy containing cefazolin and ceftriaxone were identified using routine laboratory monitoring, leading researchers to say the practice may be “excessive.”
“Our Nebraska Medicine outpatient parenteral antimicrobial therapy (OPAT) program was established in 2019 and since then our patient census has grown significantly. Due to this growth, along with finite OPAT resources, we wanted to assess the clinical utility of routine weekly laboratory monitoring for two of our program’s most commonly utilized antibiotics, particularly because the data underlying these IDSA guidelines are minimal at best,” Shawnalyn Sunagawa, PharmD, BCIDP, clinical instructor at the University of Nebraska Medical Center’s College of Pharmacy, told Healio.
“These agents were also of particular interest to us since antibiotic adverse event literature on cefazolin and ceftriaxone demonstrate that they have favorable safety profiles, and we were curious about the ability to modify specific OPAT laboratory monitoring for these antimicrobial agents,” Sunagawa said.
IDSA clinical guidelines recommend frequent laboratory testing in patients receiving OPAT.
Sunagawa and colleagues retrospectively evaluated patients prescribed either cefazolin or ceftriaxone via OPAT between March 1, 2019, and Sept. 30, 2022, excluding any patients receiving multiple intravenous antimicrobials but including those receiving concomitant oral antibiotics. The primary outcome was incidence of clinically significant OPAT-adverse events (AE) or drug-associated AEs.
In total, the study included 708 courses of OPAT comprising 22,975 days of therapy. The patients accounting for these courses of OPAT received 3,282 sets of weekly labs.
Of the 708 courses of OPAT, 366 (51.7%) contained cefazolin, with the average total duration being 31 days. The majority of patients (58.6%) completed OPAT via home health care and the most common indication for OPAT was osteomyelitis (17.2%).
According to the study, 20 (2.8%) clinically significant drug-associated OPAT-AEs were identified, with only nine (1.3%) being recognized as abnormal via routine laboratory monitoring after an average of 26 days. Three of the adverse events resulted in unplanned health care utilization. Additionally, the researchers found that the overall incidence of clinically significant OPAT-AEs detected by laboratory monitoring was 2.7 per 1,000 sets of weekly labs.
“Routine weekly laboratory monitoring for cefazolin and ceftriaxone in OPAT may be excessive and programs could likely safely implement less intensive monitoring strategies than IDSA guidelines currently recommend,” Sunagawa said.
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