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Children on IV antibiotics can leave hospital sooner

Photo: Children on IV antibiotics can leave hospital sooner
Experts have found that some children with severe infections requiring intravenous (through the vein) (IV) antibiotics, can safely have these at home instead of in hospital. This will help children to leave hospital earlier, which is better for the kids and their families.

A world-wide systematic review into the delivery of IV antibiotics by nurses visiting the child in their own home looked at whether this approach to treatment was as good as in hospital in terms of safety, cost and patient satisfaction.

The study published today in the Lancet Infectious Diseases looked at studies across Australia and the globe where children were given IV antibiotics at home and compared them to those given in hospital. The results showed that patients and families preferred to be at home and that it was cost effective for the healthcare system, freeing up beds for other patients.
The authors of the systematic review were A/Professor Penelope Bryant and Dr Naomi Katz from Murdoch Children’s Research Institute (MCRI).

First author A/Professor Bryant who is the paediatric representative of the National Hospital-in-the-Home Society, said the study was an important step in trying to get children home sooner.

“Many children in hospital are on IV antibiotics. Most parents would prefer their children to be at home if it is safe to do so. This study gives the evidence to support doctors to treat their patients with IV antibiotics at home while keeping them under daily medical review.

If we can get children safely home even one day earlier, then that’s a good thing,” she said. “Children do better psychologically at home, they get better faster, they are less at risk of hospital acquired infections, and dynamics are improved for the whole family.”

The review showed that selected patients with a variety of infections including skin infections, appendicitis, urinary tract infections, chest infections in cystic fibrosis and infections in cancer can be treated at home.

“It is likely that there are many patients currently being treated in hospital who could be treated at home, both in Australia and worldwide,” said A/Professor Bryant. “And it’s not just IV antibiotics – other traditional hospital interventions could also be given outside the hospital environment. To see just how far-reaching into improving healthcare this type of program could be, further research is needed. We are currently looking at trying to prevent some patients from having to be admitted to hospital at all.” In summary:
  • Intravenous antibiotic treatment for acute infections is increasingly used outside of the inpatient setting, but outcomes in children have not been systematically reviewed
  • We found that home-based IV antibiotics were cost-effective and satisfactory to patients and their families
  • The safety and efficacy of home-based IV antibiotics appeared to be similar to that of hospital-based treatment but the studies were not definitive  Definitive studies are needed to clarify which patient groups are most appropriate for home-based IV antibiotics and to assist in the development of guidelines to implement this model of care The next step is for doctors to actively consider IV antibiotic treatment at home as a management option for selected children with acute infections and for parents to be encouraged to ask whether their child could be treated at home.

Patient story Luca Pickwell, 15 months old, had been in hospital for cardiac surgery almost a month and had just commenced treatment of antibiotics. With 24 days of treatment remaining, Luca was able to have his daily IV antibiotics administered at home. His mother, Rebecca Danne, said she was delighted when asked about her son receiving his final treatment at home. “It was great to get back home and get back into a routine as a family again,” she said.

Rebecca said the benefits were two-fold, both freeing resources for the hospital and to have Luca at home. She said she found the experience positive. “I could not fault the process, the staff would always call before coming over, they were really responsive, clean and positive. I would definitely recommend it to other families.”

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