IV antibiotics at home is safe for kids and cheaper for families and hospitals

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Treating children with intravenous antibiotics at home is just as effective and safe as hospital treatment but substantially more cost-effective for families and hospitals, a new study has found.

Journal/conference: The Lancet Infectious Diseases

DOI: 10.1016/S1473-3099(19)30288-9

Organisation/s: Murdoch Children's Research Institute (MCRI)

Funder: • This study was funded in part by grants from the RCH Foundation, the Murdoch Children's Research Institute (MCRI), the Victorian Department of Health, Melbourne Australia. LFI was supported in part by a scholarship from AVANT Mutual Group Ltd, Melbourne, the Melbourne Children’s Campus Postgraduate Health Research Scholarship and the Doctor Nicholas Collins Fellowship. PAB was in part supported by a Melbourne Campus Clinician Scientist Fellowship, Melbourne. FEB was supported in part by a grant from the RCH Foundation and a Melbourne Campus Clinician Scientist Fellowship, Melbourne and a National Health and Medical Research Council (NHMRC) Practitioner Fellowship, Canberra. The emergency research group, MCRI, is in part supported by an NHMRC Centre for Research Excellence Grant for Paediatric Emergency Medicine, Canberra, and the Victorian government infrastructure support program.

Media Release

From: Murdoch Children's Research Institute (MCRI)

Treating children with intravenous antibiotics at home is just as effective and safe as hospital treatment but substantially more cost-effective for families and hospitals, a new study has found.

Led by the Murdoch Children’s Research Institute, the research* is the first to compare home IV antibiotic treatment with standard hospital care in a randomised study of children.

Home visits see a doctor and nurse visit to administer the antibiotics via a portable IV system.

MCRI lead researcher Dr Laila Ibrahim, who is a PhD student at the University of Melbourne, says families incur a three-fold burden of cost when their child is treated in hospital rather than home, a factor often overlooked by clinicians.

Published in The Lancet Infectious Diseases, the study focused on a common childhood infection known as cellulitis – a bacterial skin infection that causes redness, pain and swelling.

“Although all analyses were specific to management of cellulitis, they should be broadly applicable to comparison of home versus hospital treatment of other medical conditions,” Dr Ibrahim says.

The study found The Royal Children’s Hospital’s (RCH) cost per patient was $1965 for the home group over two days of treatment, compared to $3775 for the hospital group.

The mean cost incurred per family was $182 for the home group and $593 for the hospital group.

Treatment failure occurred in 2 per cent of children at home and 7 per cent of children in hospital. Adverse reactions such as diarrhea and vomiting happened less frequently at home and there was no difference in complication rates, which were very low.

Dr Ibrahim says parents/guardians took two days off work if their child was treated at hospital, compared to less than a day at home.

“This may be attributed to parents being more likely to stay with their child when they are hospitalised, whereas other carers or extended family may care for a child treated at home,” she says. “Additionally, one parent may stay with a child in hospital while the other looks after siblings at home, whereas if a child is treated at home, one parent can do all child-caring activities. This would be an especially important factor to consider for single parent families.”

MCRI and University of Melbourne Associate Professor Penelope Bryant, head of the RCH Hospital-in-the-Home program and senior author of the study, says the potential for savings across Australia is “enormous”.

She says hospitals could save a collective $4.3 million a year nationally and families $990,150, just for this one infection. This is based on a conservative estimate that 2,415 children annually who attend an emergency department with cellulitis are eligible for home intravenous treatment.

“Its use reduces hospital-acquired infections, negative psychosocial impact and the inconvenience of hospital admission,” A/Prof Bryant says. “But despite the benefits home treatment remains uncommon in children in part because of the lack of evidence for the safety and cost-effectiveness of this strategy.

“If this study could be replicated in multiple infections needing antibiotics such as urinary tract infection and febrile neutropenia, and even viral infections needing nursing observations, then the savings would be significant.”

The study involved 188 children, aged 6 months to 18 years, who presented to The Royal Children’s Hospital (RCH) Emergency Department with moderate to severe cellulitis. Participants were randomly assigned either intravenous ceftriaxone at home with a visiting nurse and doctor or intravenous flucloxacillin at hospital.

Dr Ibrahim says widespread use of home antibiotic treatment has been limited by studies pre-selecting patients for success, with no cost-effectiveness analysis in either adults or children of a hospital avoidance pathway.

“Outpatient antibiotic treatment following a hospital admission has become a widely endorsed model of care worldwide in the past decade,” she says. “This study shows the clinical and cost benefits of avoiding hospital admission altogether.”

Researchers from the University of Melbourne and The Royal Children’s Hospital also contributed to the findings.

*Publication: Laila F Ibrahim, Li Huang, Sandy M Hopper, Kim Dalziel, Franz E Babl and Penelope A Bryant. ‘Cost-effectiveness of admission avoidance with outpatient parenteral antibiotic therapy for children with moderate/severe cellulitis,’ The Lancet Infectious Diseases.

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