Comparison of hospital and home intravenous antibiotic therapy in adults with cystic fibrosis

Abstract

Aim and objective: This study aimed to compare home and hospital treatment for clinical outcome and quality of life in adult cystic fibrosis patients receiving i.v. antibiotics for acute respiratory exacerbations.

Background: Cystic fibrosis patients require intravenous (i.v.) antibiotic therapy to treat acute respiratory exacerbations. Traditionally, patients would be admitted to hospital to complete a 14-day course of i.v. antibiotics. The option of home i.v. antibiotic therapy for acute respiratory exacerbations has become an expectation of cystic fibrosis patients.

Design and method: Comparison of hospital and home i.v. antibiotic therapy in adults with cystic fibrosis for clinical outcomes and quality of life was studied using a quasi-experimental design. A pre- and post-test was used to measure clinical outcomes of forced expiratory volume in one second (FEV(1)), forced vital capacity (FVC), oxygen saturations (SaO(2)), body mass index (BMI) and quality of life using the Cystic Fibrosis Quality of Life (CFQoL) questionnaire.

Results: Thirty adult cystic fibrosis patients (15 hospital and 15 home) were recruited to the study once they had chosen where they undertook their treatment. When the groups were compared for clinical outcomes, the hospital group showed greater improvement in FVC. There were no differences in quality of life when the hospital and home groups were compared, although changes achieved with treatment showed differences. In the home group, there were improvements in all nine quality of life domains, with statistically significant improvement in five domains, whereas in the hospital group there were improvements in eight out of nine quality of life domains, with only two showing statistically significant improvement.

Relevance to clinical practice: Lung function improved more in the hospital group, suggesting that acute respiratory exacerbations were not as effectively treated at home, although there appeared to be greater quality of life when undertaking home treatment. The CFQoL questionnaire was able to detect transient changes in health status during the course of i.v. antibiotics.

Conclusion: If the patient's right to choose where they receive treatment is to be supported, taking into account quality of life further research is required to determine the reasons for home care being less clinically effective in treating acute respiratory exacerbations in cystic fibrosis patients.