DOI: 10.12688/f1000research.192917.1 ISSN: 2046-1402

Building Stewardship-Governed OPAT across African Health Systems: Documented Practice, Implementation Gaps, and Resource-Sensitive Pathways: A Narrative Review

Arnold Atuhaire, Lourita Nakyagaba, Sekitoleko Abubekar, Nkalubo Charles, Mohamed Abdinoor Mohamed, Stecia Kasemiire, Deborah Chemutai Mangusho, Mugwaneza J Claude, Babirye Shamim, Aleksandra Rutkiewicz, Gerald Olwit, Okema James Nelson, Mikolaj Madesksza
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Background African programs deliver antimicrobial injections outside hospital, but it is unclear how often these arrangements provide the functions expected of structured outpatient parenteral antimicrobial therapy (OPAT). We reviewed existing practice, service gaps and ways to develop services with antimicrobial stewardship. Methods We searched PubMed/MEDLINE, Scopus and African Journals Online through 12 October 2026, supplemented by backward and forward citation searching and targeted public-web searches. We purposively selected clinical studies, program reports, provider descriptions and guidance, grouped linked reports, and distinguished observed treatment from reported service offerings and recommendations. Results African evidence included tuberculosis, young-infant infection and Buruli ulcer programs, as well as pediatric oncology and outpatient cryptococcal meningitis care. Gray literature described home intravenous antibiotics and an announced OPAT service. Clinical studies reported outcomes in selected patients, while provider descriptions did not establish service effectiveness or coverage. Reporting of route review, monitoring responsibility and reassessment was inconsistent. Oral-treatment evidence showed that some patients can avoid continued injections. Staffing, diagnostics, medicine supply, travel and household costs shaped delivery. We synthesize existing recommendations into a pathway that first checks whether parenteral treatment is needed, then addresses prescribing responsibility, safe administration, monitoring, reassessment and escalation. Conclusions African ambulatory antimicrobial practice is broader than the formal OPAT literature suggests, but coverage and outcomes remain poorly documented. Existing and emerging services should be evaluated and strengthened without normalizing unnecessary parenteral treatment. Prospective studies should measure clinical outcomes, antimicrobial exposure, affordability and household burden before wider adoption.

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