Home intravenous antibiotic therapy: practical aspects in adults

Inpatient versus outpatient parenteral antibiotic therapy at home for acute infections in children: a systematic review

Inpatient management is necessary in many situations, but medical and allied-health treatments are increasingly being used on an outpatient basis to allow patients who would traditionally have been admitted to hospital to remain at home. Home-based clinical management has many potential benefits, including reduced hospital-acquired infections, cost savings, and patient and family satisfaction. Studies in adults provide evidence for the benefits of home-based versus hospital-based intravenous antibiotics, but few studies inform practice in home-based intravenous antibiotic therapy for children. We systematically reviewed the efficacy, safety, satisfaction, and cost of home-based versus hospital-based intravenous antibiotic therapy for acute infections in children. We searched MEDLINE (from Jan 1, 1946, to Jan 31, 2017) and Embase (from Jan 1, 1974, to Jan 31, 2017) for studies investigating home-based and hospital-based intravenous antibiotic therapy and assessed them for quality. 2827 articles were identified and 19 studies were included in the systematic review. Efficacy results differed between studies depending on the outcome assessed. The incidence of complications and readmission to hospital was similar for hospital-based and home-based treatments. In seven (47%) of 15 studies, patients who had all or part of their treatment at home received treatment for longer than patients who were treated entirely in hospital. No studies showed that home-based treatment was less safe than hospital-based treatment. In all studies in which treatment satisfaction or costs were assessed, home-based treatment was satisfactory to patients or patients' families and less expensive per episode than hospital-based treatment by 30-75%. Thus, home-based intravenous antibiotic therapy might be popular and cost-effective, but randomised studies of the efficacy of this strategy are needed. This systematic review was registered with PROSPERO (number CRD42015024406).

Assessing patient preference for two types of elastomeric infusion device

Home administration of antibiotic therapy to cystic fibrosis patients is one of many applications for the use of elastomeric infusion devices. Patient acceptability can significantly affect adherence to complex drug regimens with concordance being a concern in this patient population. While patient acceptance is often cited as a factor in pump selection, patient preference has not been assessed within a particular class of infusion device. The objective of this study was to assess patient preference for one type of elastomeric infusion device (Baxter Intermate--hard-shelled design) or another (Fresenius Kabi Eclipse--soft-shelled design). Twenty-four patients entered the study. 20/24 (83%) patients expressed a preference for the Eclipse, while 4/24 (17%) stated no preference for either device. The Eclipse device was found to be much more favourable in terms of comfort and discreetness. Patient preference should therefore be given significant consideration in order to maximize concordance with drug regimens.

Home versus hospital intravenous antibiotic therapy for acute pulmonary exacerbations in children with cystic fibrosis

To compare the effectiveness of home versus hospital intravenous (IV) antibiotic therapy for acute pulmonary exacerbations in children with cystic fibrosis (CF). A retrospective chart review was performed of 143 encounters for pulmonary exacerbations in 50 patients with CF. All encounters were categorized into two groups based on location of completion of antibiotic therapy: hospital group completed treatment in hospital (n = 64), home group completed treatment at home (n = 79). Percent change was calculated for forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), forced expiratory flow rate between 25 percent and 75 percent of vital capacity (FEF(25-75%)), maximum forced expiratory flow (FEF(max)), oxygen saturation (O2 SAT), and weight. Means of percent change (PC) from the beginning to the end of IV antibiotic treatment in outcome variables were compared. Total duration of treatment was compared between the two groups. The two groups had no significant differences at baseline in all outcome variables. Treatment of exacerbations in both groups resulted in significant improvement of lung function, O2 SATS, and weight (P <or= 0.001). The percent change in FEV1 was greater in hospital group versus home group (P = 0.04). The duration of treatment was significantly shorter in the hospital group (P = 0.001). Home and hospital IV antibiotic therapy resulted in significant improvement in lung function and weight. Hospital therapy, however, resulted in significantly greater improvement in FEV-1 and required less duration of treatment as compared to home treatment in children with CF.