Inpatient management is necessary in many situations, but medical and allied-health treatments are increasingly being used on an outpatient basis to allow patients who would traditionally have been admitted to hospital to remain at home. Home-based clinical management has many potential benefits, including reduced hospital-acquired infections, cost savings, and patient and family satisfaction. Studies in adults provide evidence for the benefits of home-based versus hospital-based intravenous antibiotics, but few studies inform practice in home-based intravenous antibiotic therapy for children. We systematically reviewed the efficacy, safety, satisfaction, and cost of home-based versus hospital-based intravenous antibiotic therapy for acute infections in children. We searched MEDLINE (from Jan 1, 1946, to Jan 31, 2017) and Embase (from Jan 1, 1974, to Jan 31, 2017) for studies investigating home-based and hospital-based intravenous antibiotic therapy and assessed them for quality. 2827 articles were identified and 19 studies were included in the systematic review. Efficacy results differed between studies depending on the outcome assessed. The incidence of complications and readmission to hospital was similar for hospital-based and home-based treatments. In seven (47%) of 15 studies, patients who had all or part of their treatment at home received treatment for longer than patients who were treated entirely in hospital. No studies showed that home-based treatment was less safe than hospital-based treatment. In all studies in which treatment satisfaction or costs were assessed, home-based treatment was satisfactory to patients or patients' families and less expensive per episode than hospital-based treatment by 30-75%. Thus, home-based intravenous antibiotic therapy might be popular and cost-effective, but randomised studies of the efficacy of this strategy are needed. This systematic review was registered with PROSPERO (number CRD42015024406).

中文翻译：

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儿童急性感染在家中住院与门诊肠胃外抗生素治疗的比较：系统评价。

在许多情况下，必须进行住院病人管理，但是越来越多的门诊病人使用医疗和专职医疗服务，以使那些原本应该住院的病人能够留在家里。基于家庭的临床管理具有许多潜在的好处，包括减少医院获得的感染，节省成本以及患者和家庭的满意度。在成年人中进行的研究提供了家庭用静脉注射抗生素相对于医院用静脉抗生素的益处的证据，但是很少有研究为儿童提供家庭用静脉注射抗生素治疗的信息。我们系统地回顾了家庭用和医院用静脉抗生素治疗儿童急性感染的疗效，安全性，满意度和成本。我们搜索了MEDLINE（从1946年1月1日到2017年1月31日）和Embase（从1974年1月1日开始，（截至2017年1月31日）进行研究，以研究基于家庭和医院的静脉内抗生素治疗并评估其质量。确定2827篇文章，并在系统评价中纳入19项研究。不同研究之间的功效结果有所不同，具体取决于评估的结果。医院和家庭治疗的并发症和再次入院的发生率相似。在15项研究中的7项（47％）中，在家中全部或部分治疗的患者比完全在医院接受治疗的患者接受的治疗时间更长。没有研究表明以家庭为基础的治疗比以医院为基础的治疗安全性低。在所有评估治疗满意度或费用的研究中，家庭治疗对患者或患者的满意度均令人满意。家庭，每次发作的费用比医院治疗便宜30-75％。因此，以家庭为基础的静脉抗生素治疗可能是流行且具有成本效益的，但是需要对该策略的疗效进行随机研究。该系统评价已在PROSPERO注册（编号CRD42015024406）。