Outpatient IV Antibiotics at Home (OPAT): Your Complete Guide

OPAT — outpatient parenteral antibiotic therapy — means you will complete your IV antibiotic treatment at home rather than in the hospital. With a PICC line and the support of a home infusion team, you can receive the same powerful antibiotics you would get in the hospital, from the comfort of your own home.

OPAT has become very common for treating serious infections including bone infections (osteomyelitis), heart valve infections (endocarditis), skin and soft tissue infections, joint infections, and many others that require weeks of IV antibiotics.

This guide walks you through every aspect of OPAT from the moment you leave the hospital.

Your OPAT Team

You will have a coordinated team supporting your OPAT course:

Infectious Disease (ID) physician or specialist: The physician (or NP/PA) directing your antibiotic therapy — choosing the antibiotic, determining the duration, and managing any complications. This is your primary medical contact for questions about your infection and treatment.

Home infusion pharmacy: Prepares and delivers your antibiotic doses to your home on a regular schedule (typically weekly). Also supplies your infusion equipment, flush syringes, and other catheter care materials.

Home infusion nurse / visiting nurse: Comes to your home for initial setup, catheter care, dressing changes, and periodic reassessment. The frequency of visits varies by your protocol — some patients have nurses daily or several times per week; others have weekly nursing visits and manage daily infusions themselves.

OPAT coordinator or case manager: The person who coordinates between your prescriber, pharmacy, and nursing service; monitors your labs; and handles prescription renewals and prior authorization.

Primary care provider: Should be kept informed of your OPAT course and will often be involved in follow-up once the antibiotic course is complete.

Who to call for what:

Questions about your antibiotic, dose, or treatment duration → ID specialist/team
Questions about your PICC or catheter care → Home infusion nurse
Supply problems or medication delivery issues → Home infusion pharmacy/coordinator
Lab scheduling → OPAT coordinator or home infusion nurse
Emergency (fever with chills, PICC problems) → Call your ID team’s after-hours line or go to the ER

Setting Up OPAT Before You Leave the Hospital

Before discharge, your care team should arrange:

A functioning PICC line (placed, confirmed, and documented)
Home infusion pharmacy identified and prescription sent
First medication delivery scheduled (ideally to arrive at or before discharge)
First home nursing visit scheduled
Antibiotic dose schedule confirmed and written down
Lab schedule established
OPAT coordinator or ID team contact information provided
After-hours contact number for emergencies
Discharge instructions reviewed and questions answered

Do not leave the hospital without all of the above in place. Ask your case manager or discharging nurse to confirm each item.

Your Antibiotic: What You Need to Know

Before going home, confirm these details and write them down:

Information	Your Details
Antibiotic name
Dose
Infusion time (how long per dose)
Frequency (how often per day)
Treatment duration (total weeks)
End date

Why IV instead of oral?

You may wonder why you cannot simply take a pill. For some infections and some antibiotics, IV is required because:

The antibiotic is not available in oral form
The oral version is not absorbed well enough to reach the concentrations needed to treat a serious infection (particularly in bones, heart valves, joints, or the spine)
Your gastrointestinal tract is compromised
The infection is severe enough that the reliability of IV delivery is preferred

In some OPAT courses, your prescriber may transition you from IV to oral antibiotics partway through — this is common as the infection improves and the IV is no longer necessary. Ask your ID team: “Is there a point where I might be able to switch to oral antibiotics?”

Managing Your Daily Infusions

Storage and preparation

Store antibiotic bags in the refrigerator until use
Remove from refrigerator 30–45 minutes before infusion time to warm to room temperature
Inspect each bag before use: clear solution, intact seal, correct drug and dose on the label, valid expiration date
Do not use a bag that is cloudy, has particles, has a broken seal, or is expired — call your pharmacy

Connecting and running the infusion

Your home infusion nurse will demonstrate your specific setup. In general:

Wash hands thoroughly (20 seconds, dry completely).
Flush the PICC with saline.
Scrub the catheter hub; attach IV tubing.
Set pump to prescribed rate or use gravity/elastomeric device as trained.
Start infusion; confirm it is running.
After infusion completes: flush PICC with saline (and heparin if prescribed).
Disconnect and cap.
Record dose in your log.

Infusion timing matters

Most IV antibiotics need to be given at evenly spaced intervals to maintain effective blood levels:

Once daily (q24h): Give at the same time each day (e.g., 8 PM nightly)
Twice daily (q12h): 12 hours apart (e.g., 8 AM and 8 PM)
Three times daily (q8h): 8 hours apart (e.g., 6 AM, 2 PM, 10 PM)
Four times daily (q6h): 6 hours apart — requires doses through the night for some patients, or may be managed with a pump that runs continuously

Missed or delayed doses can reduce the effectiveness of treatment. If you realize a dose was missed, call your pharmacy or OPAT team — do not double dose without guidance.

Lab Monitoring During OPAT

Lab monitoring is a non-negotiable part of safe OPAT. The specific labs depend on your antibiotic. Here are the most common:

Vancomycin (used for MRSA and other resistant bacteria)

AUC-based monitoring: Blood is drawn at specific times to calculate the area under the concentration curve. Your pharmacist will tell you exactly when to draw.
Kidney function (creatinine): Vancomycin can affect the kidneys; weekly monitoring at minimum, more often if kidney values change.

Beta-lactam antibiotics (ceftriaxone, cefepime, nafcillin, pip-tazo, ertapenem, meropenem)

Complete blood count (CBC): Some agents can cause neutropenia (dangerously low white blood cell count) with prolonged use — usually checked weekly.
Kidney function and liver enzymes: Routine monitoring.
Ceftriaxone specifically: Can cause biliary sludging (gallbladder issues) with long-term use; your team monitors for this.

Daptomycin

CPK (creatine phosphokinase): Daptomycin can rarely cause muscle damage; CPK is checked weekly. Report any new muscle pain or weakness.
Kidney function.

Aminoglycosides (gentamicin, tobramycin — now used less frequently)

Kidney function and drug levels very frequently — these antibiotics have a narrow therapeutic window and can cause serious kidney and hearing damage.

Do not skip labs. Abnormal values may require dose adjustments or, in some cases, a change in antibiotic. Dangerous complications can develop silently without monitoring. Your OPAT coordinator manages your lab schedule and communicates results to your prescriber.

Signs Your Treatment Is Working — and Signs It Is Not

Positive signs of improvement

Wound healing (if applicable)
Reduced fever or pain
Improved energy levels
Inflammatory markers (CRP, white blood count) trending down on labs
Imaging studies showing improvement (if applicable)

Signs that may indicate treatment failure or complication — report promptly:

Worsening of the original infection symptoms
New fever that was previously resolved
Development of a new wound drainage, increased swelling, or pain at an infected site
New side effects (see below)
Labs showing values outside the expected range

Antibiotic Side Effects to Know and Report

All antibiotics carry potential side effects. The most common and important for IV antibiotics:

Diarrhea and Clostridioides difficile (C. diff): Antibiotics disrupt normal gut bacteria. If you develop significant diarrhea — particularly watery, frequent, or foul-smelling stools — report it to your care team. C. diff is a serious intestinal infection that can develop during or after antibiotic therapy. Do not assume diarrhea will resolve on its own.

Rash: A new rash during antibiotic therapy requires evaluation. Some rashes are mild drug reactions; others can be signs of a more serious hypersensitivity. Report any rash to your OPAT team. If the rash is accompanied by hives, swelling, or breathing difficulty — this is an allergic emergency.

Kidney function changes: Certain antibiotics (vancomycin, some others) can reduce kidney function. Your labs monitor for this. Signs of kidney problems include decreased urine output, swelling in the legs, or feeling unusually fatigued.

Peripheral neuropathy (numbness/tingling in hands and feet): Associated with some antibiotics (e.g., linezolid) with prolonged use. Report promptly.

Hearing changes (tinnitus, decreased hearing): Associated with certain older antibiotics (aminoglycosides, high-dose vancomycin historically). Report any new ringing in the ears or hearing changes immediately.

Completing Your Course

The length of your OPAT course depends on the type and severity of infection. Typical durations:

Infection	Typical IV Duration
Bone infection (osteomyelitis)	4–6 weeks
Heart valve infection (endocarditis)	4–6 weeks
Joint infection (septic arthritis)	2–4 weeks
Skin/soft tissue infection	1–3 weeks
Spine infection (vertebral osteomyelitis)	6 weeks

Complete the full course. Do not stop early because you feel better. The infection may not be fully eradicated, and stopping early can lead to relapse — often with a more resistant organism.

PICC removal

At the end of your antibiotic course, your PICC is removed. Schedule this promptly — do not keep the PICC in longer than necessary. Your OPAT coordinator or home infusion nurse will arrange removal through a vascular access clinic or home visit.

Follow-up after OPAT

Your ID specialist will schedule a follow-up appointment approximately 1–4 weeks after your course completes to confirm eradication of the infection (sometimes with imaging or inflammatory markers). Ensure this appointment is scheduled before you finish treatment.

Warning Signs During OPAT

Stop infusion and call your care team if:

New rash, hives, or itching during infusion
Shortness of breath or wheezing during infusion
Nausea or vomiting that prevents you from completing a dose

Go to the Emergency Room for:

Fever (≥38°C / 100.4°F) with shaking chills — possible bloodstream infection or other serious complication; urgent
Chest pain or shortness of breath
Significant arm swelling (possible DVT)
Signs of severe allergic reaction (throat swelling, difficulty breathing)
PICC falls out or significant catheter bleeding
Worsening of the original infection (spreading redness, increasing pain, new wound drainage)

Living Well During OPAT

OPAT is temporarily disruptive but manageable. Tips from experienced OPAT patients:

Build your infusion into a routine. Anchor it to an existing habit (before bed, after dinner) so it becomes automatic.
Keep a simple log. Record each dose administered, any side effects, and daily temperature. This log is invaluable at follow-up.
Plan for supplies. Never let yourself run to the last bag or last flush syringe. Order replacements well in advance.
Protect your PICC. The PICC is your medication delivery lifeline during OPAT. Protect the dressing, avoid the arm with blood pressure cuffs, and report any site concerns promptly.
Attend all labs. Skipping labs is one of the most common reasons OPAT complications are caught late.
Ask questions freely. Your OPAT team expects questions. There are no stupid questions when managing an IV antibiotic course from home.

This guide is for educational purposes. OPAT protocols vary by institution and are highly individualized. Always follow the specific instructions of your infectious disease team, OPAT coordinator, home infusion pharmacist, and visiting nurse.