Antibiotic use prevalent in hospice patients despite limited evidence of its value

New research suggests that use of antibiotics is still prevalent among terminal patients who have chosen hospice care as an end-of-life option, despite little evidence that the medications improve symptoms or quality of life, and sometimes may cause unwanted side effects.

The use of is so engrained in contemporary medicine that 21 percent of patients being discharged from hospitals directly to a program leave with a prescription for antibiotics, even though more than one fourth of them don't have a documented infection during their .

About 27 percent of hospice patients are still taking antibiotics in the final week of their life.

This raises serious questions about whether such broad and continued antibiotic use is appropriate in so many hospice cases, experts say, where the underlying concept is to control pain and protect the remaining quality of life without aggressively continuing medical treatment.

Additional concerns with antibiotic use, the study concluded, include medication side effects and adverse events, increased risk of subsequent opportunistic infections, prolonging the dying process and increasing the risk of developing antibiotic resistant microorganisms.

The findings were just published in Antimicrobial Agents and Chemotherapy by researchers from Oregon State University and the Oregon Health & Science University. It was supported by the National Institutes of Health.

"Hospice care is very patient centered and in terminal patients it focuses on palliative care and symptom relief, not curative therapy," said Jon Furuno, an associate professor in the Oregon State University/Oregon Health & Science University College of Pharmacy.

"It's not for everyone, and it's a serious decision people usually make in consultation with their family, nurses and doctors. These are tough conversations to have.

"Having decided to use hospice, however, the frequency and prevalence of antibiotic use in this patient population is a concern," Furuno said. "Antibiotics themselves can have serious that sometimes cause new problems, a factor that often isn't adequately considered. And in terminally-ill people they may or may not work anyway."

Issues such as this, Furuno said, continue to crop up in the evolving issue of , which is still growing in popularity as many people choose to naturally allow their life to end with limited medical treatment and often in their own homes. Hospice is covered by Medicare for people with a life expectancy of less than six months, helps to control medical costs and reduce hospital stays, and its services are now used by more than one third of dying Americans.

Unnecessary and inappropriate antibiotic use is already a concern across all segments of society, researchers said in the report, and more efforts are clearly needed to address the issue in hospice patients. The design of the study probably leads to it underestimating the significance of the problem, the researchers wrote in their conclusion.

add to favorites email to friend print save as pdf

Related Stories

Choosing hospice care isn't always easy

Jul 07, 2014

(HealthDay)—Hospice care is an option for people who have terminal illnesses, but choosing the right hospice isn't always easy, experts say.

Louisiana shelves cut to Medicaid hospice program

Jan 24, 2013

(AP)—Louisiana Gov. Bobby Jindal's administration has scrapped plans to shutter the state's Medicaid hospice program in February, meaning the state will continue to provide end-of-life care to people on their death beds ...

Recommended for you

A new tool in drug overdose prevention

5 hours ago

The Center for Disease Control reported earlier this month that the heroin overdose death rate across 28 states it surveyed doubled between 2010 and 2012. This sharp increase and the chilling statistics that say more than 11 ...

Nasal spray treats heroin overdose

Oct 28, 2014

"Every year, drug overdoses are responsible for roughly 1000 ambulance calls in Oslo," says Arne Skulberg, an anaesthesiologist, a PhD candidate at NTNU and the 2014 winner of Norway's Researcher Grand Prix ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.