Nearly 50% of patients approaching the end of life have an infection. Still, the use of antimicrobial therapy in this patient population is controversial, and the clinical benefits are unclear.
When deciding whether to treat an infection, it is important to weigh the patient’s prognosis from the underlying illness, the time it takes for the antimicrobials to work, their impact on prognosis, available routes of administration, and anticipated side effects.
Time to effect varies significantly depending on the causative organism, site of infection, and antimicrobial medication.
The following information from the medical literature may be useful when considering the use of antimicrobials.
- Antimicrobial therapy has not been shown to provide consistent symptomatic relief in dying adults. In a review that analyzed the symptom response following administration of an antimicrobial via many routes for patients in palliative care, improvement varied from 21.4% to 56.7% of cases. Symptomatic improvement may be more likely for urinary tract infections (60-92% symptomatic response) than for respiratory tract infections (0-53% symptomatic response). There was no observed symptom improvement among patients with bacteremia.
- When prognosis is anticipated to be weeks to months, there is little evidence that antimicrobials provide significant survival benefit. However, when prognosis from the underlying illness is anticipated to be longer (e.g., months to a year), antibiotics may offer a survival benefit.
- Antimicrobials are not the only therapeutic option for managing infection-related symptoms. Other options are: opioids for dyspnea secondary to a respiratory infection; antitussives for bronchitis-associated cough; otic suspensions for otalgia from otitis media; pyridium for bladder spasms secondary to a urinary tract infection; and antipyretics for symptoms from fever.
Potential problems of antimicrobial therapy are adverse effects (diarrhea), burdens related to route of administration (phlebitis, local soft tissue infections), and costs (it can be expensive)
See reference for more information.
Adapted from Jablonski L, Pruskowski J. Antimicrobial therapy at the end of life. Palliative Care Network of Wisconsin. Fast facts and concepts #351. Internet. Accessed on May 2, 2018.