Intravenous antibiotics for treating pediatric skin infections can be administered as effectively in the patient’s home as in hospital, and could be better for the children’s quality-of-life.
This is the conclusion of a paper published in The Lancet Infectious Diseases (Mar. 7, 2019).
In a press release from the Murdoch Children’s Research Institute (MCRI) in Parkville, Victoria, Australia, the paper’s lead author Dr. Laila Ibrahim said that intravenous antibiotic therapy is increasingly being conducted in a home setting, even though there have been no clinical trials supporting its benefits.
Dr. Ibrahim is a PhD student at MCRI.
The research team says this is the first trial worldwide in children that has compared IV antibiotic treatment at home to hospital.
Known as the Cellulitis at Home or Inpatient in Children from the Emergency Department (CHOICE), the trial was a randomized, controlled, non-inferiority trial in children aged six months to 18 years who presented to the emergency department at The Royal Children’s Hospital (RCH) in Melbourne, Australia with uncomplicated moderate to severe cellulitis. A total of 190 participants were randomly assigned to receive either intravenous ceftriaxone (50 mg/kg once daily) at home or intravenous flucloxacillin (50 mg/kg every six hours), of whom 188 completed the study.
Dr. Ibrahim said 95% of the parents of the children in the study reported high satisfaction rates of having their child treated at home—much higher than in hospital.
“Being in hospital negatively impacts a child’s mental and emotional health and disrupts family routine,” she said. “We keep admitting children to hospital because there have been no good studies showing that treatment at home is as good as hospital treatment.”
Among the children in the home group, treatment failure occurred in just 2% of cases, compared to 7% in the hospital group. As well, adverse events including diarrhea and vomiting happened less often at home. No difference was seen in rates of complications, which were low in both groups. Repeat insertions of cannulas or drips was also lower (3%) in the home compared to 18% for children in hospital.
“What makes this trial even more ground-breaking is that the children in the home group were never even admitted to hospital,” said co-senior author Penelope Bryant, PhD. Dr. Bryant is an associate professor and head of the RCH Hospital-in-the-Home program.
“Doctors need to be confident that sending a child home for IV antibiotics directly from emergency is efficacious and safe,” she said. “For the first time we have truly shown that, and by avoiding hospital admission altogether, children also avoid risks such as hospital-acquired resistant infections. Just as importantly, families preferred it and children were more able to get on with day-to-day family life.”
The cost of treating a patient with cellulitis at home is AUD$530 per day compared to AUD$1,297 per day at hospital. It cost over AUD$100,000 more in total to care for the 95 children in hospital during the study than the 93 children in the at-home group.
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