Discussion

Abstract

CF patients, especially those who are chronically infected with Pseudomonas aeruginosa, often need frequent hospital admissions because of recurrent exacerbations of disease. Intravenous administration of high-dose antibiotics directed against the causative microorganisms is generally considered the best way to treat these exacerbations.1Høiby N Friis B Jensen R Koch C Møller NE Stöving S Szaff M Antimicrobial chemotherapy in cystic fibrosis patients.Acta Paediatr Scand [Suppl]. 1982; 301: 75-100Crossref Scopus (73) Google Scholar To increase the efficacy of therapy and to reduce the chance of development of resistant strains, a combination of aminoglycosides and ß-lactam antibiotics is usually chosen. Several North American studies have been conducted to investigate the feasibility and the efficacy of administration of intravenous antibiotics at home.2Stiver HG Telford GO Mossey JM et al.Intravenous antibiotic therapy at home.Ann Intern Med. 1978; 89: 690-693Crossref PubMed Scopus (105) Google Scholar, 3Kind AC David DN Persons G Gibson GA Intravenous antibiotic therapy at home.Arch Intern Med. 1979; 139: 413-415Crossref PubMed Scopus (75) Google Scholar, 4Stiver HG Trosky SK Cote DD Oruck JL Self administration of intravenous antibiotics: an efficient, cost-effective home care program.CMA J. 1982; 127: 207-211PubMed Google Scholar, 5Poretz DM Eron LJ Goldenberg RJ Gilbert A Rising J Sparks S Horn CE Intravenous antibiotic therapy in an outpatient setting.JAMA. 1982; 248: 336-339Crossref PubMed Scopus (136) Google Scholar, 6Rehm SJ Weinstein AJ Home intravenous antibiotic therapy: a team approach.Ann Intern Med. 1983; 99: 388-392Crossref PubMed Scopus (96) Google Scholar, 7Donati MA Guenette G Auerbach H Prospective controlled study of home and hospital therapy of cystic fibrosis pulmonary disease.J Pediatr. 1987; 111: 28-33Abstract Full Text PDF PubMed Scopus (81) Google Scholar Such home treatment seems to be an attractive option for CF patients; the possible advantages include less interruption of daily life for patients and families, less time lost from work or education, and a considerable savings in cost. From these studies it is clear that organization of home treatment requires intensive cooperation among hospital pharmacists providing the intravenous antibiotic mixtures, nurses experienced in intravenous antibiotic administration, and physicians responsible for the medical care of the patient involved in such a home treatment program. In some studies nurses paid daily visits to the patients at home to check for phlebitis or to replace the intravenous needles and to provide new intravenous supplies. Alternatively, patients have had to return daily to the hospital. Home treatment also requires a physician, nurse, and pharmacist always to be on call. In one study it was estimated that about one third of the direct costs of a home treatment program was spent on the salaries of a part-time pharmacist and a part-time nurse.5Poretz DM Eron LJ Goldenberg RJ Gilbert A Rising J Sparks S Horn CE Intravenous antibiotic therapy in an outpatient setting.JAMA. 1982; 248: 336-339Crossref PubMed Scopus (136) Google Scholar Health insurance companies did not always approve 100 percent reimbursement of the costs of home treatment. Two major obstacles to organizing home treatment in The Netherlands are (1) trained nurses are often not available, and may not be permitted to make home visits; and (2) health insurance companies will not pay for antibiotics supplied by the hospital but administered at home. Home treatment for CF patients might be easier to organize if it can be demonstrated that antibiotics given once or twice daily are as effective as more frequently administered antibiotics and do not lead to increased toxicity or the development of resistant strains.