A new prospective cohort study on the use of domiciliary intravenous (IV) antibiotic therapy in patients with non-cystic fibrosis bronchiectasis entitled “A prospective cohort study of the use of domiciliary intravenous antibiotics in bronchiectasis” was recently published in Primary Care Respiratory Medicine by Dr. Pallavi Bedi from Queen’s Medical Research Institute. The study’s findings, which show positive patient outcomes for home-administered intravenous antibiotics, could lead to improved antibiotic treatment options for dealing with lung infections in bronchiectasis.
Bronchiectasis is a chronic incapacitating respiratory disease. Patients suffer with daily cough, production of excess sputum, and frequent chest infections because of inflamed and permanently damaged airways. In Scotland, where the study was conducted, bronchiectasis is a frequently occurring disease, with an incidence of 1 in 1,000 subjects. The treatment of bronchiectasis consists of airway clearance and treatment of infections with antibiotics that are sometimes administered intravenously in the most severe cases. Outpatient and domiciliary parenteral antibiotic therapy programs, which are often effective healthcare channels for offering treatment to those with bronchiectasis, are well-recognized and acceptable alternative forms of providing healthcare in the community worldwide. However, the UK has been relatively slow in adopting the application of domiciliary intravenous antibiotics. In cystic fibrosis, domiciliary IV antibiotic therapy has already been implemented, but not in non-cystic fibrosis bronchiectasis, where the cohort of patients are middle aged and older with co-morbid conditions when compared to a relatively younger cohort in cystic fibrosis.
In this study, Dr. Pallavi Bedi and colleagues assessed the efficacy and safety of domiciliary IV antibiotic therapy in patients with non-cystic fibrosis bronchiectasis to promote treatment with patient-centered domiciliary as an alternative of hospital inpatient treatment. In this study, the patients were recruited prospectively over 5 years from December 2006 to December 2011 from the Royal Infirmary of Edinburgh, UK. The study included 116 patients that would receive 196 courses of IV antibiotics. For inpatient therapy, 8 courses were administered to 32 early supported discharge (ESD) patients and 84 domiciliary therapy patients. Patients were taught to self-administer IV antibiotics via a cannula, midline catheter, or a totally implanted port—the midline catheter was the mode used by most patients. In the case of an acute exacerbation episode, the domiciliary intravenous (IV) team — which included a respiratory physician leading the bronchiectasis service in NHS Lothian, a specialist registrar, a clinical nurse specialist, a physiotherapist, and a respiratory pharmacist — would prescribe an extra 14-day domiciliary IV therapy or ESD with domiciliary IV therapy.
The researchers found that there was significant clinical and quality of life improvement in all groups, with clearance of infection in 76%, 80%, and 80%, respectively, in the inpatient, ESD, and domiciliary groups. Morbidity was recorded in 13.8% in the inpatient group, 9.4% in the ESD group, and 14.2% in the domiciliary IV group. There were no mortality rates in any of the groups. The rates of readmission at day 30 after treatment were 13.8%, 12.5% and 14.2%, respectively, in the inpatient, early supported discharge, and domiciliary groups. Total bed days saved was 1,443. In conclusion, the researchers found that the domiciliary IV antibiotic therapy in bronchiectasis is clinically effective and safe for this cohort of patients.