Caring for kids where they belong: home IV antibiotic therapy

19 August 2019 | Avant media

“Why can’t we bring the hospital to the child?” asks upbeat paediatrician and clinician-scientist, Dr Laila Ibrahim, introducing her world-first study and the subject of her PhD.

She has proven that treating children with antibiotics through an intravenous drip at home is just as effective and safe as hospital treatment, and is better for their quality of life.

The study, for which Dr Ibrahim received an Avant Doctor in Training Research Scholarship, has been published in The Lancet Infectious Diseases.

Dr Penny Browne, Chair of the Avant Foundation Board said, “We are delighted with the success of this study and the springboard this scholarship has proven to be for Dr Ibrahim.”

Family satisfaction high

“We keep admitting children to hospital because there have been no good studies showing that treatment at home is as good as hospital treatment,” lead author and Murdoch Children’s Research Institute post-doctoral researcher, Dr Ibrahim says.

The trial involved 188 children, aged six months to 18 years, who presented to the emergency department at The Royal Children’s Hospital, Melbourne with moderate to severe cellulitis. Participants were randomly assigned either intravenous ceftriaxone at home with a nurse and doctor visiting the home or intravenous flucloxacillin at hospital.

Ninety-five percent of parents in the study reported high satisfaction rates having their child treated at home, much higher than in hospital.

“Most parents tell me it’s nothing like what they imagined. They imagine having to be the nurse in the situation and having to look after the child, which is not what we advocate for. We say, ‘You’re the parent and we’ll send the nurse and doctor out to you,’” she explains.

Stunning results

Treatment failure occurred in 2% of children in the home group and in 7% of children in the hospital group. Adverse reactions such as diarrhea and vomiting happened less frequently at home and there was no difference in complication rates, which were very low.

Repeat insertions of IV cannulas or drips were 3% in the home, in comparison to 18% for children in hospital.

Dr Ibrahim says it’s likely other infections could be treated in the same way. “We’re going to apply the same model to other sorts of infections, for example, lymphadenitis and urinary tract infections. One infection at a time, we’re going to change practice,” she says.

Dr Ibrahim is currently working on mandating this enhanced method of treatment by updating the guidelines at The Royal Children’s Hospital where she works. The hospital already has a Hospital-in-the-Home program to support children going home directly from emergency.

Cost savings nothing to sneeze at

Dr Ibrahim says treatment in the home also has significant cost-saving benefits.

The cost of treating a patient with cellulitis at home is $530 per day compared to $1,297 per day in hospital. In total, it cost over $100k more to care for the 95 children in hospital during the study, compared with the 93 at home.

Big surprises for this once career clinician

What came as a surprise for Dr Ibrahim, was how addicted she became to doing the research itself.

“I really thought this would have been a stop-over for me. I’m a clinician, a paediatrician and I thought I’ll do my PhD for three years, focus on research and go back to full time work. I thought I would be heading to full-time clinician practice, with a strong interest in research. But now, after the last three-and-a-half years, it’s actually the opposite!” she laughs.

It was the second job she landed in Melbourne back in 2012, after relocating from Ireland that sparked her interest in pursuing this area for research.

“What kicked off this whole idea was that I used to be the doctor who did home visits. I saw how amazing this treatment at home was for children,” she says. “I was also very lucky to meet my supervisor and mentor, Associate Professor Penelope Bryant, head of the RCH Hospital-in-the-Home program, who was passionate about treating children at home and a research study started'.

Dr Ibrahim says that together they approached Professor Franz Babl, Head of Paediatric Emergency Medicine Research at the Royal Children’s Hospital, to collaborate on this study.

“Professor Babl, being a clinician in a busy Emergency Department at the Royal Children’s Hospital, was keen to get children out of hospital and from there, the trial just got bigger and better,” she says.

While Dr Ibrahim has recently been awarded the prestigious Clinician-Scientist Fellowship at the Murdoch Children’s Research Institute, she says her children keep her grounded.

“My husband and I are both doctors and he goes to work with a stethoscope around his neck and I go with a laptop. My children say, ‘You’re not really a doctor are you?’” she laughs.

Joviality aside, Dr Ibrahim is serious about improving outcomes for children through home treatment, “To go into a child’s home into their bedroom and treat them, there’s nothing like it. It’s where they belong. If it were up to me, I’d have every doctor do home consultations so they can see how it makes sense. This is what healthcare should be,” she says.

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