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. 2004 Mar;59(3):242–246. doi: 10.1136/thx.2003.005876

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

J Thornton 1, R Elliott 1, M Tully 1, M Dodd 1, A Webb 1
PMCID: PMC1746976  PMID: 14985563

Abstract

Methods: A retrospective longitudinal study was performed to compare the clinical outcome over a period of 1 year of all patients attending the Manchester Adult CF Unit who received intravenous antibiotics at home or in hospital. The primary outcome measure was percentage change in forced expiratory volume in 1 second (FEV1) at the end of the 1 year period. Baseline "best" and "average" FEV1 values were established for each patient for the year before the study. The secondary outcome measures were percentage changes in forced vital capacity (FVC) and body weight.

Results: A total of 116 patients received 454 courses of intravenous antibiotics. At the end of 1 year there had been a mean percentage decline in FEV1 compared with the baseline "average" for patients treated mostly at home but an improvement in patients treated mostly in hospital (Tukey's HSD mean difference 10.1%, 95% CI 2.9 to 17.2, p = 0.003). For all patients there was a mean percentage decline in FEV1 from the baseline "best" value. For each course of treatment the mean percentage improvements in FEV1 at the end of the course from the start of the course were significantly higher for patients treated in hospital than for those treated at home.

Conclusions: Clinical outcome, as defined by spirometric parameters and body weight, was better after a course of treatment in hospital than after home treatment, and this benefit was maintained over 1 year of treatment. The results suggest that patients treated at home need closer supervision.

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Selected References

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  1. Amin N., Dozor A. J. Effects of administration of aerosolized recombinant human deoxyribonuclease on resting energy expenditure in patients with cystic fibrosis. Pediatr Pulmonol. 1994 Sep;18(3):150–154. doi: 10.1002/ppul.1950180306. [DOI] [PubMed] [Google Scholar]
  2. Bell S. C., Saunders M. J., Elborn J. S., Shale D. J. Resting energy expenditure and oxygen cost of breathing in patients with cystic fibrosis. Thorax. 1996 Feb;51(2):126–131. doi: 10.1136/thx.51.2.126. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Black N. Why we need observational studies to evaluate the effectiveness of health care. BMJ. 1996 May 11;312(7040):1215–1218. doi: 10.1136/bmj.312.7040.1215. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bosworth D. G., Nielson D. W. Effectiveness of home versus hospital care in the routine treatment of cystic fibrosis. Pediatr Pulmonol. 1997 Jul;24(1):42–47. doi: 10.1002/(sici)1099-0496(199707)24:1<42::aid-ppul7>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  5. Bradley J. M., Wallace E. S., Elborn J. S., Howard J. L., McCoy M. P. An audit of the effect of intravenous antibiotic treatment on spirometric measures of pulmonary function in cystic fibrosis. Ir J Med Sci. 1999 Jan-Mar;168(1):25–28. doi: 10.1007/BF02939576. [DOI] [PubMed] [Google Scholar]
  6. Corey M., McLaughlin F. J., Williams M., Levison H. A comparison of survival, growth, and pulmonary function in patients with cystic fibrosis in Boston and Toronto. J Clin Epidemiol. 1988;41(6):583–591. doi: 10.1016/0895-4356(88)90063-7. [DOI] [PubMed] [Google Scholar]
  7. Dodd M. E., Webb A. K. Understanding non-compliance with treatment in adults with cystic fibrosis. J R Soc Med. 2000;93 (Suppl 38):2–8. [PMC free article] [PubMed] [Google Scholar]
  8. Donati M. A., Guenette G., Auerbach H. Prospective controlled study of home and hospital therapy of cystic fibrosis pulmonary disease. J Pediatr. 1987 Jul;111(1):28–33. doi: 10.1016/s0022-3476(87)80337-2. [DOI] [PubMed] [Google Scholar]
  9. Elphick Heather E., Tan Anton, Ashby Deborah, Smyth Rosalind L. Systematic reviews and lifelong diseases. BMJ. 2002 Aug 17;325(7360):381–384. doi: 10.1136/bmj.325.7360.381. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gilbert J., Robinson T., Littlewood J. M. Home intravenous antibiotic treatment in cystic fibrosis. Arch Dis Child. 1988 May;63(5):512–517. doi: 10.1136/adc.63.5.512. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Knudson R. J., Lebowitz M. D., Holberg C. J., Burrows B. Changes in the normal maximal expiratory flow-volume curve with growth and aging. Am Rev Respir Dis. 1983 Jun;127(6):725–734. doi: 10.1164/arrd.1983.127.6.725. [DOI] [PubMed] [Google Scholar]
  12. MacDonald A. Nutritional management of cystic fibrosis. Arch Dis Child. 1996 Jan;74(1):81–87. doi: 10.1136/adc.74.1.81. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Packe G. E., Hodson M. E. Changes in spirometry during consecutive admissions for infective pulmonary exacerbations in adolescent and adult cystic fibrosis. Respir Med. 1992 Jan;86(1):45–48. doi: 10.1016/s0954-6111(06)80147-2. [DOI] [PubMed] [Google Scholar]
  14. Pond M. N., Newport M., Joanes D., Conway S. P. Home versus hospital intravenous antibiotic therapy in the treatment of young adults with cystic fibrosis. Eur Respir J. 1994 Sep;7(9):1640–1644. doi: 10.1183/09031936.94.07091640. [DOI] [PubMed] [Google Scholar]
  15. Rosenfeld M., Davis R., FitzSimmons S., Pepe M., Ramsey B. Gender gap in cystic fibrosis mortality. Am J Epidemiol. 1997 May 1;145(9):794–803. doi: 10.1093/oxfordjournals.aje.a009172. [DOI] [PubMed] [Google Scholar]
  16. Strandvik B., Hjelte L., Malmborg A. S., Widén B. Home intravenous antibiotic treatment of patients with cystic fibrosis. Acta Paediatr. 1992 Apr;81(4):340–344. doi: 10.1111/j.1651-2227.1992.tb12239.x. [DOI] [PubMed] [Google Scholar]
  17. Torgerson D. J., Sibbald B. Understanding controlled trials. What is a patient preference trial? BMJ. 1998 Jan 31;316(7128):360–360. doi: 10.1136/bmj.316.7128.360. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Winter R. J., George R. J., Deacock S. J., Shee C. D., Geddes D. M. Self-administered home intravenous antibiotic therapy in bronchiectasis and adult cystic fibrosis. Lancet. 1984 Jun 16;1(8390):1338–1339. doi: 10.1016/s0140-6736(84)91829-4. [DOI] [PubMed] [Google Scholar]
  19. Wolter J. M., Bowler S. D., Nolan P. J., McCormack J. G. Home intravenous therapy in cystic fibrosis: a prospective randomized trial examining clinical, quality of life and cost aspects. Eur Respir J. 1997 Apr;10(4):896–900. [PubMed] [Google Scholar]

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