Home intravenous antibiotics for cystic fibrosis (Cochrane Review)

A substantive amendment to this systematic review was last made on 07 July 2000. Cochrane reviews are regularly checked and updated if necessary.

Background: Recurrent endobronchial infection in cystic fibrosis requires treatment with intravenous antibiotics for several weeks, which is usually administered in hospital, affecting health costs and quality of life for patients and their families. It is not known whether patients receiving intravenous treatment at home have better or equivalent health outcomes, if costs are reduced or if it is preferred than in-hospital treatment. Home treatment requires training to patients and carers and usually needs a few previous days in hospital.

Objectives: To determine whether home intravenous antibiotic therapy in cystic fibrosis is as effective as in-patient intravenous antibiotic therapy and if it is preferred by patients and/or families.

Search strategy: References to trials were obtained from the cystic fibrosis trials register held by the editorial base of the Cochrane Cystic Fibrosis and Genetic Disorders Group. Handsearching of the abstracts books of all Spanish Conferences on cystic fibrosis and the last European Conference (Stockholm, 2000) was carried out by authors.Date of the most recent search of the Group's specialised register: April 2002.

Selection criteria: Randomized controlled trials where home intravenous antibiotic treatment for patients with cystic fibrosis was compared with in-hospital intravenous antibiotic treatment, including adults and children with cystic fibrosis. All kinds of antibiotics and regimens administered intravenous were included.

Data collection and analysis: Three reviewers independently selected the trials to be included in the review, assessed methodological quality of each trial and extracted data using a standardised form. Because of several limitations, narrative synthesis was used at this stage.

Main results: Seven studies were identified by the initial search. One study reporting results from a total of 17 patients aged 10 to 41 years with an infective exacerbation by Pseudomonas aeruginosa was included in the review. All their 31 admissions were analysed as independent events. Outcomes were measured at 21 days of follow-up after initiation of treatment. Home patients had fewer investigations performed than hospital patients (p<0.002) and general activity was higher in the home group. No significant differences were found for clinical outcomes, adverse events, complications of intravenous lines or line changes or time to next admission. Home patients 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 patients, 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.

Reviewers' conclusions: The current evidence is restricted to one small study. It suggests that in the short term home therapy does not harm patients and in general reduces social disruptions. The decision to attempt home treatment should be based on an individual basis and appropriate local resources. More research is urgently required.

Citation: Marco T, Asensio O, Bosque M, de Gracia J, Serra C. Home intravenous antibiotics for cystic fibrosis (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

---

This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

The Cochrane Library is designed and produced by Update Software Ltd.

Update Software Ltd, Summertown Pavilion, Middle Way, Oxford OX2 7LG, UK
(Tel:+44 1865 513902; Fax:+44 1865 516918)

File Reference: AB001917.htm