Antibiotic Use at the End of Life: Current Practice and Ways to Optimize.
Minji Kang, Winnie S Wang, Zieanna Chang
PMID 39030663WHAT IT FOUND
Antibiotics are common near the end of life, but they do not reliably relieve symptoms except in some urinary tract infections.
They can add burden, side effects, and resistance. Discuss goals, prognosis, and comfort-focused options before starting or continuing them.
Key findings
01Antibiotics are frequently used at the end of life. They often continue after comfort measures are started, and in inpatient settings 46% to 87% of patients received antibiotics during the last week of life.
02Symptom relief is uncertain and infection-specific. No randomized trials were found, and in terminal cancer relief was seen in 15 to 48%, with up to 79% improvement in painful urination from urinary tract infection but little improvement in respiratory, mouth/pharynx, or skin infections.
03Antibiotic use at the end of life can add burden, adverse effects, longer stays, cost, and multidrug-resistant organisms. It is often started without clear evidence of infection.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a review, not an original trial, and it does not report search or appraisal methods, so the evidence base cannot be checked from the supplied text. The cited evidence on symptom relief is mostly observational, and the paper states there are no randomized trials evaluating antibiotics for symptom relief at the end of life. Reported antibiotic use rates vary widely because studies used different patient populations, settings, definitions of end of life, and infection definitions. The paper gives practice recommendations, but it does not test whether these changes improve outcomes.
Declared interests
The authors declared no potential conflicts of interest and received no financial support.
The easy way to misread this
Do not read this review as proof that antibiotics reliably relieve end-of-life symptoms. The benefit data are observational and vary by infection, with little improvement shown for respiratory, mouth/pharynx, or skin infections, so decisions should be based on the specific symptom, prognosis, and patient goals.