www.thelancet.com/infection Vol 18 February 2018 e45 Review Lancet Infect Dis 2018; 18: e45–54 Published Online August 16, 2017 http://dx.doi.org/10.1016/ S1473-3099(17)30345-6 Hospital-in-the-Home Department (N T Katz FRACP, P A Bryant PhD) and Infectious Diseases Unit (P A Bryant), The Royal Children’s Hospital, Parkville, VIC, Australia; Clinical Paediatrics Group, Murdoch Children’s Research Institute, Melbourne, VIC, Australia (N T Katz, P A Bryant); and Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia (P A Bryant) Correspondence to: Dr Penelope A Bryant, Hospital- in-the-Home Department, The Royal Children’s Hospital Melbourne, Parkville, VIC 3052, Australia penelope.bryant@rch.org.au Inpatient versus outpatient parenteral antibiotic therapy at home for acute infections in children: a systematic review Penelope A Bryant, Naomi T Katz Inpatient management is necessary in many situations, but medical and allied-health treatments are increasingly being used on an outpatient basis to allow patients who would traditionally have been admitted to hospital to remain at home. Home-based clinical management has many potential benefts, including reduced hospital- acquired infections, cost savings, and patient and family satisfaction. Studies in adults provide evidence for the benefts of home-based versus hospital-based intravenous antibiotics, but few studies inform practice in home- based intravenous antibiotic therapy for children. We systematically reviewed the efcacy, safety, satisfaction, and cost of home-based versus hospital-based intravenous antibiotic therapy for acute infections in children. We searched MEDLINE (from Jan 1, 1946, to Jan 31, 2017) and Embase (from Jan 1, 1974, to Jan 31, 2017) for studies investigating home-based and hospital-based intravenous antibiotic therapy and assessed them for quality. 2827 articles were identifed and 19 studies were included in the systematic review. Efcacy results difered between studies depending on the outcome assessed. The incidence of complications and readmission to hospital was similar for hospital-based and home-based treatments. In seven (47%) of 15 studies, patients who had all or part of their treatment at home received treatment for longer than patients who were treated entirely in hospital. No studies showed that home-based treatment was less safe than hospital-based treatment. In all studies in which treatment satisfaction or costs were assessed, home-based treatment was satisfactory to patients or patients’ families and less expensive per episode than hospital-based treatment by 30–75%. Thus, home-based intravenous antibiotic therapy might be popular and cost-efective, but randomised studies of the efcacy of this strategy are needed. This systematic review was registered with PROSPERO (number CRD42015024406). Introduction As the need for hospital beds increases, delivery of medical interventions outside of traditional hospital- inpatient settings has become increasingly attractive. Home-based treatment has many potential benefts including reduced hospital-acquired infections and other hospital-associated adverse events, cost savings, and patient and family satisfaction. Treatment at home might be provided by medical, nursing, or allied health professionals or by patients self-administering treatment. 1 One of the most common interventions provided at home—replacing a traditional hospital model—is the administration of intravenous antibiotics or home-based outpatient parenteral antibiotic therapy (OPAT). Numerous studies 1–5 have compared home-based versus hospital-based intravenous antibiotic therapy in adults, and overall the evidence is conficting. One systematic review 1 in adults showed that home-based treatment was associated with reductions in mortality, hospital readmissions, and costs, as well as improved consumer satisfaction, whereas a Cochrane review 2 found insufcient evidence that home-based care confers better economic or health outcomes than hospital-based care. In children, although the impetus to treat their infections at home is arguably greater than for adults, outcomes for home-based treatment compared with treatment in hospital are poorly understood. Few comparative studies have analysed children and no systematic review has been done. This Review aimed to compare the efcacy, safety, satisfaction, and cost of home-based intravenous antibiotic treatment versus hospital-based treatment for acute infections in children. Although OPAT can be administered in a medical treatment centre, for the purpose of this Review, OPAT solely referred to intravenous antibiotics delivered in patients’ homes. Antibiotics might have been administered by nurses or by patients or their families. Key messages • 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 outpatient parenteral antimicrobial therapy (OPAT) was cost-efective and satisfactory to patients and their families • The safety and efcacy of home-based OPAT appeared to be similar to that of hospital-based treatment, but these outcomes should be treated with caution as most studies were not randomised • A potential disadvantage of home-based OPAT is that patients treated at home might have a longer total duration of treatment than those treated in hospital • Paediatricians should actively consider intravenous antibiotic treatment at home as a management option for selected children with acute infections • Prospective, randomised studies are needed to clarify which patient groups are most appropriate for home-based OPAT and to assist in the development of guidelines to implement this model of care Downloaded for Anonymous User (n/a) at University of Melbourne from ClinicalKey.com.au by Elsevier on May 02, 2018. 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