Long-term outcomes of pharmacist-led complex outpatient antimicrobial therapy for bone and joint infections: a comparative analysis with OVIVA Study data
Introduction: Bone and joint infections (BJIs) are associated with significant morbidity and healthcare costs. The OVIVA trial demonstrated that oral antibiotics are non-inferior to intravenous (IV) therapy, reducing hospital stays and complications.1 Building on this evidence, Complex Outpatient An...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
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| Series: | Clinical Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1470211825001484 |
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| Summary: | Introduction: Bone and joint infections (BJIs) are associated with significant morbidity and healthcare costs. The OVIVA trial demonstrated that oral antibiotics are non-inferior to intravenous (IV) therapy, reducing hospital stays and complications.1 Building on this evidence, Complex Outpatient Antimicrobial Therapy (COPAT) programmes, particularly those led by pharmacists, have emerged as a promising approach to further optimise the management of BJIs by enhancing adherence, monitoring and patient-centred care.2 However, the long-term outcomes and patient satisfaction of pharmacist-led COPAT programs remain underexplored. This study evaluated the efficacy and patient-centred outcomes of a pharmacist-led COPAT clinic compared with OVIVA trial data. Materials and Methods: We conducted a retrospective cohort study of 112 patients treated in a pharmacist-led COPAT clinic for BJIs between January 2020 and May 2024. Data on demographics, infection type, antimicrobial regimens, adverse drug reactions (ADRs) and clinical outcomes were collected from electronic and written patient records. Long-term outcomes, including 1-year recurrence rates and patient satisfaction, were compared with OVIVA trial data. Descriptive statistics were used to summarise the findings. Results and Discussion: The cohort had a median age of 65 years, with a male preponderance (64%). Treatment was complex, with a median duration of 57 days; 62 patients (55%) received combination antimicrobial therapy. ADRs necessitating treatment modifications occurred in 46 patients (41%), primarily because of rifampicin (24%) and doxycycline (22%). Overall outcomes were excellent, with 107 patients (96%) achieving cure or improvement at the end of treatment. One patient (1%) was readmitted because of worsening infection, and four (3%) were lost to follow-up. Patient satisfaction with the service was high, with 95% reporting positive experiences. Compared with the OVIVA trial, the COPAT cohort demonstrated a lower 1-year recurrence rate (2% vs 14%) and higher patient satisfaction (95% vs 87%) (Table 1). Conclusion: Pharmacist-led COPAT clinics provide a safe and effective alternative to intrravneous (IV) therapy for BJIs, with superior long-term outcomes and higher patient satisfaction compared with OVIVA. These findings support the broader implementation of COPAT programs, highlighting the critical role of pharmacists in optimising antimicrobial therapy and reducing healthcare costs. Future multicentre studies are needed to validate these results and explore cost-effectiveness. |
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| ISSN: | 1470-2118 |