Home Intravenous Antibiotic Protocols for Acute Pulmonary Exacerbations in Patients With Cystic Fibrosis: A Scoping Review

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Background: Patients with cystic fibrosis (CF) experience multiple episodes of acute pulmonary exacerbation (APE) throughout their lifetime. Intravenous antibiotic therapy (IVAB) is the current standard of treatment. Home administration of IVABs is generally considered a safe alternative to hospital treatment which reduces disruption to the lives of patients with CF. This scoping review aimed to identify the characteristics and components of home IVAB treatments or protocols that have been reported for treatment of APE in patients with CF. Methods: A scoping review was conducted to examine original research on home IVAB treatment for APE in patients with CF. Studies that included only pediatric patients or antibiotic administration for prevention of APE were excluded. Medline and CINAHL were searched. Study selection and data extraction was performed independently by 2 reviewers. Results: Eleven studies, published from 1997 to 2022, were included. Overall, there was minimal information reported among the studies about criteria for eligibility to receive IVABs at home. Some studies excluded patients requiring supplemental oxygen, intravenous nutrition, transplant recipients, and those requiring a combination of antibiotics. Few studies required a formal assessment of antibiotic administration competency. Additionally, there were insufficient descriptions of the types of antibiotics administered in the home, and no formal protocols were evident among the research for the treatment of patients with CF experiencing APE. Conclusions: This review highlighted a need for standardized protocol for home IVAB for APE, with potential to improve CF management for patients and practitioners, with impacts on outcomes such as lung function, symptom severity, and quality of life.