Indications for Home Intravenous Antibiotic Treatment
There are 2 broad indications for home intravenous antibiotic treatment:
(1) To treat infective and symptomatic exacerbations of chronic lung disease. The clinical benefits are well documented.
(2) To reduce lung colonization by harmful bacterial pathogens with regular antibiotic prophylaxis and thus to minimize permanent lung damage. The clinical benefits remain to be proved.
Home Therapy versus Hospital Therapy
Strieder and colleagues have demonstrated that aggressive hospital treatment of respiratory exacerbations in CF resulted in improved lung function studies. Others* have compared respiratory care in the hospital with home treatment in children and adults with CF. The prospective controlled study of Donati et al demonstrated that both types of therapeutic approaches resulted in significant differences between the two groups of children, both on admission to study and at the end of observations (Table 1).
Both groups received 16 to 20 days of intravenous antibiotic therapy. The smaller study of Martinez et al involving adults showed similar improvements in respiratory function tests and body weight in the hospital and home care patients (Table 2). there
There are similar findings from other groups (Kuzemko, unpublished observations). Review of the results of respiratory home care studies with those of Strieder and colleagues demonstrates further that home therapy is as effective as aggressive hospital treatment In addition, home care therapy is extremely cost-effective: approximately $10,000 ($600 per day) for a single treatment episode, versus $18,000 ($1,000 per day) for similar in-hospital treatment.
The Intravenous Procedure
The generally accepted method is the use of an intravenous cannula and heparin lock system—ie, a dose of heparin and saline solution is injected into the cannula and locked in by occluding the port with a bung.
Table 1—Admission and Discharge Pulmonary Function Studies for Home Care and Hospitalized Patients
|VC (% pred.):|
|Discharge||68.9 ±3.9||71.1 ± 3.7|
|FEVi (% pred.):|
|Admission||31||43.5 ±4.0||32||37.5 ±2.7|
|p = .005||p<.001|
|PFR (% pred.):|
|Admission||29||63.5 ±4.3||31||55.8 ±3.5|
|PaOa (mm Hg):|
|Discharge||69.9 ±2.0||68.6 ±2.5|
|p = .006||p<.001|
Table 2—Body Wright (kg) in CF Patients Treated at Home or in the Hospital