Expert explores use of antibiotics at end of life

Antibiotics and other antimicrobials are often administered to terminally ill patients. But given widespread concern about antibiotic resistance, this common practice should be reconsidered by providers, patients, and families, according to a Yale researcher.

In an opinion piece published online in JAMA, Associate Professor of Medicine in the Section of Infectious Diseases, Dr. Manisha Juthani-Mehta, and her co-authors note that nearly 90% of hospitalized patients with terminal cancer, and 42% of nursing home residents with dementia, receive antimicrobials in their final weeks of life. While antimicrobials—which include antibiotic, antiviral, and antifungal agents—may help relieve symptoms of illness and prolong life, they also present significant risks, including adverse drug reactions, drug interactions, and infection.

The JAMA paper also noted that there is little data on the effect of antimicrobials in these patients. "To date, no rigorously conducted study has reported the survival outcomes of patients in the final stages of other terminal diseases who did and did not receive antimicrobials for suspected infections," the authors wrote.

Juthani-Mehta and her co-authors recommend that providers and terminally ill patients discuss the pros and cons of antimicrobials during advance care planning. "Just as many other aspects of end-of-life care are being reconsidered, improving palliative care requires reassessment of the best use of antimicrobials in the final weeks of life," they said.