Antibiotic prescription for fever episodes in hospice patients

Abstract

Bacterial infection usually plays an important part in the fever episodes that are common in patients in the hospice palliative care unit. The physicians' attitude to use of antibiotics in such cases is usually complex. We retrospectively studied 535 admissions to a hospice and palliative care unit in a medical center in Taiwan. Ninety-three fever episodes (16.7%) were identified among these admissions, and 79 fever episodes (84.9%) were treated with antibiotics. The Karnofsky performance status (KPS), verbal communication ability (VCA) and Glasgow Coma Scale (GCS) were all significantly compromised in these febrile patients. Although KPS, VCA and GCS were similar among all patients at the date of admission, these parameters became significantly worse in fever episodes that were left untreated than in those treated with antibiotics. Patients without antibiotic treatment showed a shorter mean survival (8.7 +/- 9.9 days vs 14.6 +/- 13.1 days; P = 0.03) and a higher 3-day mortality rate than those patients with antibiotic treatment (50% vs 15.2%; P = 0.015). In conclusion, appropriate antibiotic use may cause fever to subside and thus decrease the fever-related discomfort. Physicians may tend to withhold antibiotic treatment because of the poorer KPS, VCA, and GCS and poorer estimated prognosis of patients at the time of fever.

Antimicrobial Use for Symptom Management in Patients Receiving Hospice and Palliative Care: A Systematic Review

“…6,[8][9][10][11][12]14 Six studies included only cancer patients. 8,[12][13][14][15][16] Four studies included all primary diagnoses requiring palliative care or consult.…”

“…8,[12][13][14][15][16] Four studies included all primary diagnoses requiring palliative care or consult. 6,7,9,10 One study included only dementia patients. 11 Only one study reported prophylaxis as an indication for antimicrobial prescription, citing use in two patients for traumatic urinary catheter insertion.…”

“…After reviewing these articles and those that were cross-referenced, we identified 11 publications that met all study criteria and which were therefore included in our systematic review. [6][7][8][9][10][11][12][13][14][15][16] Characteristics of these studies are displayed in Table 1. Sample size ranged from 70 to 1598 patients (median = 150 patients).…”

“…Sample size ranged from 70 to 1598 patients (median = 150 patients). Six of the studies were conducted in North America, 10,11,[13][14][15][16] one in Europe, 6 three in Asia, 8,9,12 and one in Australia. 7 Six studies were conducted in hospitals, [7][8][9][10]12,13 two in home-based hospice programs, 15,16 one in an inpatient hospice, 6 one in a long-term care facility, 11 and one study was conducted in multiple care settings (acute hospital, tertiary palliative care unit, and hospice).…”

Changes in Life-sustaining Treatment in Terminally Ill Cancer Patients after Signing a Do-Not-Resuscitate Order

“…오히려 부종이나 흉막 삼출액, 호흡곤란, 객담 등의 증상이 더 악화될 수 있으며, 특히 흉막 삼출액 증상이 심해졌다는 보고가 있다 (6). 그 외에도 말기환자가 감염증상이 있을 때 흔 히 항생제를 처방하고 있으나, 생명연장에 대한 기대는 논쟁의 여지가 있다 (7,8). 말기환자의 항생제 사용에 대 한 연구에서 환자의 64∼84%가 항생제가 처방되었고 (9-11), 국내연구에서 55%는 증상개선이 없었으며, 15% 정도만 증상이 개선되었다 (9,10).…”