Efficacy and safety of home-based intravenous antibiotic therapy among adults: a systematic review

Abstract

The aim of this study was to identify, systematically assess and summarise the available evidence about the efficacy and safety of intravenous home antibiotic therapy. In this systematic review, we considered studies of adults with any kind of infection and recommended intravenous antibiotic therapy. We included studies comparing therapy given at the patient's home versus any other setting (other levels of healthcare services or sites). We performed wide and sensitive literature searches with strategies adjusted for each of the electronic databases, including CINAHL, ClinicalTrials.gov, Cochrane Library, Embase, Epistemonikos, Health System Evidence, LILACS, MEDLINE and grey literature (OpenGrey). We used the Cochrane risk-of-bias and GRADE tools to evaluate the risk of bias and the certainty of evidence. At least two reviewers, working independently, selected the studies, extracted data and critically evaluated the evidence. We performed random-effects meta-analyses where possible. From 20 099 references initially identified, we included 6 randomised controlled trials (RCTs) with 616 participants. We considered the certainty of the body of evidence as low to very low regarding infection resolution after 6 weeks, risk of adverse events, mortality and clinical status. Based on six RCTs with considerable risk of bias, this systematic review found low or very low evidence about the advantages of intravenous antibiotic therapy at home. The imprecision of the results does not allow us to recommend or contraindicate the use of this strategy in clinical practice. [PROSPERO register: this review protocol was prospectively submitted at the PROSPERO register base at 31 January 2021 (submission no. 42021234454)].