Study design (if review, criteria of inclusion for studies)
Randomized and quasi-randomized controlled studies of intravenous antibiotic treatment for adults and children with CF at home compared to in hospital.
List of included studies (1)
Wolter 1997
Participants
The review includes adults and children with CF diagnoses defined clinically and by sweat or genetic testing, including all ages and all degrees of severity, and who receive IV antibiotic treatment.
Interventions
Home intravenous antibiotics
Outcome measures
Primary outcomes 1. Lung function (change in per cent predicted or absolute change in FEV1, change in forced vital capacity (FVC), any other lung function parameters) 2. Lung infection (conversion of sputum from culture positive to culture negative, reduction in colony forming units (CFU) counts for P. aeruginosa and other micro-organisms) 3. Improvement of clinical score
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.
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.