Long term clinical outcome of home and hospital intravenous antibiotic treatment in adults with cystic fibrosis

Location and Duration of Treatment of Cystic Fibrosis Respiratory Exacerbations Do Not Affect Outcomes

“…Subjects receiving therapy entirely in the home setting were more likely to be female than in other groups. This gender phenomenon has been reported previously (13,14). When looking at the data by exacerbation, subjects who received therapy entirely in the hospital were younger than other groups and those receiving therapy entirely in the home were older than other groups.…”

“…Currently, there is little evidence to direct physicians' therapies of exacerbations. Prior studies have provided conflicting results as to the efficacy of intravenous antibiotic therapy administered at home compared with that administered in the hospital (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). The only prospective randomized study of the venue of antibiotic administration for respiratory exacerbations in patients with CF published to date found that there was no difference in lung function by therapy venue (7).…”

“…Additionally, several studies have documented no difference between inpatient and outpatient therapy in terms of compliance with antibiotic therapy (5) or improvement in FEV 1 (4)(5)(6)(7)(10)(11)(12)(13). Conversely, other studies have shown a significantly greater improvement in FEV 1 after inpatient treatment compared with outpatient treatment (9,(14)(15)(16)(17). It is important to recognize that most studies have consisted of fewer than 100 patients in a few clinical sites, which may have resulted in limited power and clinic-specific biases.…”

Extending the course of intravenous antibiotics in adult patients with cystic fibrosis with acute pulmonary exacerbations

“…18,19 This was supported by a recent retrospective analysis of 1535 adolescent and adult patients with CF, where the site of the treatment did not affect the return to baseline of FEV1. 15 In contrast, carefully planned studies in adult 20 and in paediatric patients with CF 21 reported less favourable results for home treatment of PExs with respect to lung function tests and BMI compared with either hospital treatment or treatment that was started in hospital and completed at home.…”

“…The number of patients was relatively modest. Given the limited number of patients with CF available in most adult CF units and the unique approach for home support adapted in this research programme, our study, like other studies, 20,21 treated and analysed each PEx as a separate event. Similarly, due to the modest number of patients, factors that might contribute to the extension of antibiotics such as CF related diabetes and ABPA were not examined.…”