Intravenous antibiotics given at home for people with cystic fibrosis

Review question

We reviewed the evidence about the effect of giving antibiotics at home to people with cystic fibrosis.

Background

Cystic fibrosis is a serious genetic disease linked to recurrent lung infections. As a result of these infections, the person's lung disease becomes progressively worse. Lung infections are often treated with intravenous antibiotics (given directly into a vein) in hospital for a number of weeks. This is costly and disrupts the life of people with cystic fibrosis. Treatment can be given at home if patients and their carers are given enough training and support. We looked for randomised controlled trials which compared intravenous antibiotic treatment in hospital with treatment at home. This is an update of a previously published review.

Search date

The evidence is current to: 23 November 2015.

Study characteristics

We found one study with 17 people aged 10 to 41 years who had a flare up of infection with Pseudomonas aeruginosa. The people taking part were assigned to either home antibiotics or hospital antibiotics at random. Those who had home antibiotics initially spent up to four days in hospital and were taught to prepare and administer their own intravenous antibiotics. They were discharged with enough medication and equipment for the course of treatment and were visited at home. All participants received the same type of antibiotic and the course lasted at least 10 days.

Key results

There were no differences found for clinical outcomes, adverse events, or complications linked to intravenous treatment. People at home were more tired and found the treatment more difficult to master. This may be due to them being more active and needing more support. Home therapy was cheaper for families and the hospital. There were no details about indirect costs. We conclude that treatment at home does not harm people in the short term and does reduce social disruption. However, the decision in favour of this option must be made on an individual basis.

Quality of the evidence

The evidence is very limited and more research is strongly needed to recommend its use.

Authors' conclusions: 

Current evidence is restricted to a single randomized clinical trial. It suggests that, in the short term, home therapy does not harm individuals, entails fewer investigations, reduces social disruptions and can be cost-effective. There were both advantages and disadvantages in terms of quality of life. The decision to attempt home treatment should be based on the individual situation and appropriate local resources. More research is urgently required.

Read the full abstract...
Background: 

Recurrent endobronchial infection in cystic fibrosis requires treatment with intravenous antibiotics for several weeks usually in hospital, affecting health costs and quality of life for patients and their families. This is an update of a previously published review.

Objectives: 

To determine whether home intravenous antibiotic therapy in cystic fibrosis is as effective as inpatient intravenous antibiotic therapy and if it is preferred by individuals or families or both.

Search strategy: 

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.

Most recent search of the Group's Trials Register: 23 November 2015.

Selection criteria: 

Randomized and quasi-randomized controlled studies of intravenous antibiotic treatment for adults and children with cystic fibrosis at home compared to in hospital.

Data collection and analysis: 

The authors independently selected studies for inclusion in the review, assessed methodological quality of each study and extracted data using a standardised form.

Main results: 

Eighteen studies were identified by the searches. Only one study could be included which reported results from 17 participants aged 10 to 41 years with an infective exacerbation of Pseudomonas aeruginosa. All their 31 admissions (18 hospital and 13 at home after two to four days of hospital treatment) were analysed as independent events. Outcomes were measured at 0, 10 and 21 days after initiation of treatment. Home participants underwent fewer investigations than hospital participants (P < 0.002) and general activity was higher in the home group. No significant differences were found for clinical outcomes, adverse events, complications or change of intravenous lines,or time to next admission. Home participants received less low-dose home maintenance antibiotic.

Quality of life measures showed no significant differences for dyspnoea and emotional state, but fatigue and mastery were worse for home participants, possibly due to a higher general activity and need of support. Personal, family, sleeping and eating disruptions were less important for home than hospital admissions.

Home therapy was cheaper for families and the hospital. Indirect costs were not determined.

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