Many terminally ill patients are prescribed antibiotics in the last two weeks of their lives, and often those antimicrobials are prescribed without adequate symptoms supporting a bacterial infection.
There is no definitive data suggesting antibiotic use by terminally ill patients increases comfort or extends life, according to an article published in JAMA. The authors recognize addressing antibiotic use with terminally ill patients and family can be difficult, and they provide the following tips to help clinicians make decisions about antimicrobial use in palliative care.
1. Plan ahead of time. Instead of waiting until a "time of a crisis," clinicians should include decision-making about antimicrobial use as part of advance care planning. Preferences should be well-documented in advance directives.
2. Educate the patient and family. According to the article, "The risks and burdens of evaluating and treating an infection should be presented [to patients and families], as well as possible benefits, while acknowledging the lack of high-quality outcome data."
3. Learn the patient's goals and preferences. After all parties have been educated, clinicians need to work with patients and their family members to align care with the patients' preferences. "If the preference is only for treatments that optimize comfort, it is reasonable to recommend that no evaluation be initiated for a suspected infection and palliative care provided."
The authors suggest that clinicians make evidence-based and goal-directed counseling on infection management for terminally ill patients "a routine part of advance care planning and treatment discussions." They also suggest that a randomized clinical trial comparing comfort and survival levels of patients who receive antibiotics versus those who receive palliative care for suspected infections may be necessary.