Seven outpatient parenteral antimicrobial therapy guidelines vary widely in methodological and reporting quality

A systematic review searched bibliographic databases from inception to 14 July 2026, with hand-searching, for clinical practice guidelines on outpatient parenteral antimicrobial therapy, including English-language guidelines only Synthesis (Lim et al., PMID 42869139). Seven guidelines met the criteria, the earliest released in 2004 and the most recent in 2026, almost all published or revised within the last ten years. Most aimed to standardise the delivery, safety and effectiveness of OPAT in their own healthcare settings.

The authors appraised them with AGREE II for methodological quality and RIGHT for reporting quality. The average overall methodological quality score was 81.0% and the average overall reporting quality score was 61.6%, with a positive correlation between AGREE II and RIGHT domain scores. They found substantial heterogeneity in quality and reporting completeness and, although clear clinical recommendations were noted, a lack of evidence-synthesis methods and quality assurance. They conclude that robust and transparent guidelines are critical to safe, sustainable and equitable expansion of outpatient antimicrobial care.

This is a review of guidelines and not of outcomes: it says nothing about whether patients treated under any of them fared better or worse, and it reports nothing on patient experience. The abstract does not identify which seven guidelines were included, so it cannot be confirmed whether UK guidance is among them, and only English-language guidelines were eligible.

The implication is for anyone setting local OPAT selection criteria, monitoring arrangements or stewardship oversight against published recommendations: the guidelines available to base them on differ in how they were built, and reporting completeness is the weaker of the two measured domains.