Antibiotic Use in the Last Week of Life in Three Different Palliative Care Settings

Abstract

The purpose of this study was to examine the frequency and types of antibiotics prescribed in the last week of life in three different palliative care settings, including an acute care hospital, tertiary palliative care unit, and three hospice units. A total of 150 consecutive patients were evaluated, 50 in each of the three settings. Twenty-nine patients (58%) in the acute hospital setting, 26 (52%) in the tertiary palliative care unit, and 11(22%) in the hospice settings were prescribed antibiotics. In the acute care and tertiary palliative care settings, the most frequent route of antibiotic administration was intravenous and, in the hospice setting, oral. We conclude that there is marked variability in the numbers and types of antibiotics prescribed in these different palliative care settings in the last week of life. The high use of intravenous antibiotics and the large number of patients who were still receiving antibiotics at the time of death indicate the need for further prospective studies.

The Pattern of Antimicrobial Use for Palliative Care In-Patients During the Last Week of Life

“…8,9 A previous report from Canada has suggested that antibiotic treatment for terminally ill cancer patients is more predominant in an acute care hospital and a TPCU than in hospice setting. 6 Reports from Canada, Hong Kong, and South Korea have shown higher prevalence of antibiotic use among terminally ill cancer patients compared to our findings. 6,8,10 Nonetheless, we believe that the use of antimicrobials in our TPCU is a fairly common practice even when patients are in their final days of life.…”

“…6 Reports from Canada, Hong Kong, and South Korea have shown higher prevalence of antibiotic use among terminally ill cancer patients compared to our findings. 6,8,10 Nonetheless, we believe that the use of antimicrobials in our TPCU is a fairly common practice even when patients are in their final days of life. Indeed, close to one third of patients who received antibiotics in our sample were on more than one antibiotic during their last week of life.…”

Palliative inpatients in general hospitals: a one day observational study in Belgium

“…In our survey, the treatment objective was generally clearly noted by the health care providers: transfusions and antibiotics were used largely to alleviate symptoms; whereas admission to the intensive care unit, artificial nutrition, and specific disease-related treatments were used more to prolong life. Undoubtedly, interventions such as antibiotics may contribute to a better management of distressing symptoms [31]. Furthermore, the long-term prognosis of some patients and uncertainty about the short-term prognosis in others may encourage a mixed management strategy and an interaction between a curative and palliative approach.…”

Antibiotics in palliative medicine—results from a prospective epidemiological investigation from the HOPE survey

“…There is little epidemiological information on the use of antibiotics in palliative care in Germany and only some information from other countries, for example, from Canada [5][6][7], Australia [8], and Norway [9]. Some studies consider the application of antibiotics in the terminal phase of a progressive disease not useful [10,11], whereas other studies describe the importance of antibiotic treatment as a part of symptom control in palliative medicine [8].…”