Comparison Of Home And Hospital Intravenous Antibiotic Therapy For Clinical Outcome In Patients With A Pulmonary Exacerbation Of Cystic Fibrosis. Do They Always Need To Be Admitted?

INTRODUCTION: Canadian Cystic Fibrosis (CF) patients spent over 24,900days in hospital and underwent 867 home intravenous (IV) antibiotic treatments in 2014. CF pulmonary exacerbations are treated with IV antibiotic therapy, either in hospital or at home. Yet, there is insufficient evidence to advocate for one site versus the other.OBJECTIVES: To compare the effects of home versus hospital IV antibiotic therapy on the outcome for treatment of pulmonary exacerbation for adults with CF.METHODS: A retrospective, chart review was conducted of patients treated for CF pulmonary exacerbation either at home or in hospital. Measures included short and long-term changes in spirometry parameters and treatment failure.RESULTS: 91 episodes of exacerbation were included (46 treated at hospital, and 45 at home). Age, gender, home location (near a tertiary care hospital versus peripheral location) and income were similar between the two groups. There were no significant changes in FEV1% predicted (ppFEV1) between the two groups (difference of changes (95% CI) 0.49% (-3.54% to 4.53%)). Complications and readmission rates were similar. Patients without a caregiver at home and those with lower pre-treatment ppFEV1 were more likely to be treated at hospital.CONCLUSION: Home-based intravenous antibiotic therapy is as safe and as effective as hospital-based therapy, with appropriate patient selection.