Adult

COPAT-Supported Anti-infective Therapy

The Complex Outpatient Antimicrobial Therapy (COPAT) service provides governance, clinical oversight, and monitoring for patients receiving antimicrobial therapy outside the inpatient setting.

Referral to COPAT is mandatory for all patients planned for discharge on:

  • Intravenous antimicrobial therapy for 14 days or longer, OR for less than 14 days and requiring additional monitoring as recommended by Micro/ID
  • Linezolid for longer than 14 days, to ensure appropriate haematological monitoring.

COPAT aims to support safe, effective, and patient-centred OPAT, favouring once-daily (or, rarely, twice-daily) regimens where clinically appropriate, and ensuring antimicrobial stewardship, monitoring, and clear lines of responsibility.

Governance and Clinical Responsibility

All patients managed via COPAT remain under the care of a named consultant clinician from the parent specialty team.

The parent team retains responsibility for:

  • Overall clinical care and escalation of concerns,
  • Responding to COPAT queries during treatment,
  • Arranging end-of-treatment review and follow-up, where required.

COPAT provides treatment coordination, monitoring, MDT review, and escalation to Micro/ID where concerns arise.

Referral Process

  • Referrals must be made via EPR → Communicate → Pool → OPAT Team, using the ~R-OPAT_Referral proforma.
  • All referrals must also be discussed with the COPAT team on ext. 57190 or bleep 8118.
  • Micro/ID approval is required for all antimicrobial courses exceeding 72 hours (during working hours), in line with antimicrobial stewardship principles.
  • Referrals should be submitted at least 48 hours prior to the anticipated discharge date.
  • The final discharge date must be agreed with the COPAT team to ensure safe service provision.
  • The ambulatory pharmacist can be contacted on ext. 26178 for medication-related queries.

COPAT-Supported Treatment Modalities

1. Elastomeric Devices

(24-hour continuous infusions, changed daily by COPAT/H@H clinicians)

Available agents:

Requirements:

  • Suitable only for patients clinically stable and assessed as appropriate for COPAT.
  • Generally limited to patients residing within Oxfordshire due to service constraints.
  • Patients must receive at least one supervised inpatient dose prior to OPAT commencement.
  • Prescribing must be via the Elastomeric PowerPlan, generating a compliant TTO including correct diluent and volumes.
  • All patients must have appropriate vascular access (PICC or midline), inserted and checked according to Trust policy.

 

2. Nurse-Delivered Regimens

Once-daily regimens*

**Caution: Prothrombin time, INR and APTT may increase on cefazolin treatment courses, please monitor. For more information see Cefazolin associated coagulation disorders

Twice-daily regimens*

  • cefazolin** 500mg–2g BD (CrCl less than 35 mL/min)
  • ceftazidime 1g–2g BD (CrCl less than 50 mL/min)

**Caution: Prothrombin time, INR and APTT may increase on cefazolin treatment courses, please monitor. For more information see Cefazolin associated coagulation disorders

Thrice-weekly regimens* (post-haemodialysis)

**Caution: Prothrombin time, INR and APTT may increase on cefazolin treatment courses, please monitor. For more information see Cefazolin associated coagulation disorders

Amphotericin B Liposomal and amikacin may be supported as part of a defined continuation phase, following discussion with Micro/ID and COPAT.

 

Once-weekly agents*

Use is Micro/ID-led, with dosing based on indication, weight, renal function, and microbiological data.

*Other regimens may be supported following MDT discussion with Micro/ID and COPAT.

Important points for nurse-delivered regimens:

  • Administration is undertaken by trained clinicians in the patient’s home.
  • Ambulatory patients may attend AAU/Rowan daily if required.
  • All regimens must be prescribed via the COPAT PowerPlan, ensuring safe and standardised prescribing. Regimens not included in the PowerPlan can be discussed with the pharmacist to ensure correct drug, diluents and flushes are prescribed.
  • Except in exceptional circumstances, patients require a PICC or midline catheter.

 

3. Patient-Delivered (Self-Administered) COPAT

Selected patients (or carers) may self-administer IV antimicrobials where this is safe, appropriate, and preferred.

  • Suitability must be assessed by COPAT, considering:
    • Clinical stability,
    • Cognitive and physical ability,
    • Home environment and support.
  • Antimicrobial selection should be discussed with Micro/ID
  • Patients must complete structured training and be formally assessed as competent prior to discharge.
  • Training typically requires 3–5 supervised sessions, depending on experience.

Monitoring and Safety

Linezolid and Oral Antimicrobials

  • Patients discharged on linezolid for longer than 14 days must be referred to COPAT for weekly FBC monitoring.
  • Monitoring of other oral antimicrobials may be required in higher-risk patients and should be agreed with Micro/ID and COPAT.

Intravenous COPAT Monitoring

In line with BSAC standards:

  • All patients receiving IV antimicrobials via COPAT will have weekly FBC, U&Es, LFTs and CRP.
  • Blood tests are performed by the AHAH team or local nursing teams and reviewed at the weekly COPAT MDT.
  • Clinical deterioration, laboratory abnormalities, line complications, or antimicrobial toxicity will prompt escalation to Micro/ID and the parent clinical team.

Editorial Information

Last reviewed: 02 Feb 2026

Next review date: 01 Feb 2029

Author(s): Co-pat team.

Approved By: ASG