Work

Development of a national outpatient parenteral antimicrobial therapy (OPAT) pathway for skin and soft tissue infections in Scotland

Year: 2026

Type: article

Abstract: Background and objectives: The Scottish Antimicrobial Prescribing Group (SAPG) formed a multidisciplinary outpatient parenteral antimicrobial therapy (OPAT) working group in September 2020 to develop a national consensus on OPAT treatments and to support service development. Methods: The development of a national OPAT skin and soft tissue (SSTI) clinical pathway for adults was identified as a key initiative to support admission avoidance. The pathway was modelled on an established pathway in one health board and agreed by consensus with representation from 12 of the 14 territorial Scottish health boards. A survey to assess pathway uptake was conducted in February 2025, and a follow-up survey of boards that had not adopted the pathway was conducted in April 2026. Results: IV ceftriaxone was agreed by the SAPG as initial OPAT SSTI therapy, with daptomycin or teicoplanin as alternatives, and with dalbavancin to support care of vulnerable adults or if daily IV therapy was not possible. The pathway was circulated to all health boards in June 2022. By April 2026 the pathway had been adopted by 11 (2 island and 9 mainland) health boards across 28 separate acute services including OPAT, hospital at home, emergency departments and ambulatory care units. The remaining three health boards reported OPAT activity but without formal adoption of the pathway. Conclusions: A national OPAT SSTI pathway has been successfully developed and rolled out across approximately 91% of the adult population in Scotland, including remote and rural areas. Further work to evaluate use and wider rollout is ongoing.

Source: JAC-Antimicrobial Resistance

DOI: 10.1093/jacamr/dlag227