A comparison of in-hospital and HITH-based treatment of respiratory exacerbations in children with bronchiectasis

Abstract

Introduction: Children with bronchiectasis have recurrent exacerbations and many require hospitalisation. ‘Hospital in the home (HITH)’ is an alternative to hospitalisation for children with Cystic-Fibrosis(CF) but there is little data in those without CF. We describe our experience of HITH in a cohort of children with bronchiectasis and compared outcomes between hospital- and HITH-based pathways. Methods: Medical records were retrospectively reviewed in children with bronchiectasis who were hospitalised in our centre from Jan-2017 to June-2018. We assessed treatment duration, symptom resolution, oral antibiotic prescription on discharge, adverse events and time to next exacerbation. Results: We analysed 54 exacerbations (HITH n=38, 70%) in 46 children [median age=4.5 (IQR 2-10.25) years; females=26, Indigenous=6]. Mean (SD) IV antibiotic therapy was for 14.9 (2.7) days. There was no difference in duration of treatment between the HITH [median=14 (IQR 14-16.25) days] vs. hospital groups [14 (14-14); p=0.65]. 21/38 (55.2%) children in the HITH group had symptom resolution at end of IV treatment compared to 10/16 (62.5%) in the hospital group; p=0.62 with 26% children in the HITH group discharged on oral antibiotics compared to 47% of the hospital group; p=0.13. There was no difference in time to next exacerbation between groups [HITH median=12 (7-15.75) weeks, hospital=9(6-24)]. No difference in adverse events was seen between the two groups. Conclusions: A high proportion of pulmonary exacerbations in children with bronchiectasis requiring IV antibiotics are managed with HITH. The equivalence of HITH to inpatient treatment remains conjectural until prospective studies are undertaken.