Why the study?
Does domiciliary IV antibiotic therapy improve clinical outcomes and reduce hospital bed days in patients with non-cystic fibrosis bronchiectasis exacerbations compared to inpatient therapy?
Does domiciliary IV antibiotic therapy improve clinical outcomes and reduce hospital bed days in patients with non-cystic fibrosis bronchiectasis exacerbations compared to inpatient therapy?
Domiciliary intravenous antibiotic therapy is a safe and effective alternative to inpatient treatment for acute exacerbations of non-cystic fibrosis bronchiectasis, significantly reducing hospital bed days.
Supports domiciliary IV therapy for bronchiectasis exacerbations; hypothesis-generating observational data requiring RCTs before practice change.
We introduced domiciliary intravenous (IV) antibiotic therapy in patients with bronchiectasis to promote patient-centred domiciliary treatment instead of hospital inpatient treatment. To assess the efficacy and safety of domiciliary IV antibiotic therapy in patients with non-cystic fibrosis bronchiectasis. In this prospective study conducted over 5 years, we assessed patients’ eligibility for receiving domiciliary treatment. All patients received 14 days of IV antibiotic therapy and were monitored at baseline/day 7/day 14. We assessed the treatment outcome, morbidity, mortality and 30-day readmission rates. A total of 116 patients received 196 courses of IV antibiotics. Eighty courses were delivered as inpatient treatment, 32 as early supported discharge (ESD) and 84 as domiciliary therapy. There was significant clinical and quality of life improvement in all groups, with resolution of infection in 76% in the inpatient group, 80% in the ESD group and 80% in the domiciliary group. Morbidity was recorded in 13.8% in the inpatient group, 9.4% in the ESD group and 14.2% in the domiciliary IV group. No mortality was recorded in either group. Thirty-day readmission rates were 13.8% in the inpatient group, 12.5% in the ESD group and 14.2% in the domiciliary group. Total bed days saved was 1443. Domiciliary IV antibiotic therapy in bronchiectasis is clinically effective and was safe in our cohort of patients. Safe and effective antibiotic therapy for bronchiectasis can be provided at home, improving patients' quality of life. Bronchiectasis is a chronic respiratory condition in which inflamed airways trigger excess mucus and frequent chest infections. Flare-ups often lead to hospitalization and antibiotic treatment. In order to reduce pressure on hospitals and improve patients' quality of life, Pallavi Bedi at Queen's Medical Research Institute, Edinburgh, UK, and colleagues conducted a study into the feasibility of providing intravenous antibiotic treatment at home. Over five years, the team monitored 116 patients whenever they required antibiotics. Those patients capable of correctly self-medicating were taught how to administer antibiotics at home. Of 196 courses of antibiotics, 84 were delivered at home.The team found that home-based treatment was as safe and effective as hospital treatment, saving 1,443 hospital bed days.
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Bedi et al. (2014) studied this question.
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