D'Agata and Mitchell identified factors that can to decide if antibiotic use may be unnecessary or even harmful for a patient at the end of life. Administration of antibiotics is relatively common even there is no possible benefit to the patient. The authors are from Beth Israel Deaconess Medical Center and Hebrew Senior Life Institute for Aging in Boston.
Patients at the end of life whom may receive antibiotics unnecessarily:
(1) advanced dementia
(2) terminal cancer
(3) terminal disease (AIDS, COPD, heart disease, etc) on palliative care
Administering antibiotics should not be done as a reflex but rather with goals in mind:
(1) Will the antibiotic prolong life to a meaningful extent?
(2) Will the administration of the antibiotic be more of a burden than benefit to the patient?
(2a) Will administering the antibiotics be uncomfortable for the patient?
(2b) Will the patient need to be restrained to administer the medication?
(2c) Is the patient at risk for adverse reactions from the medication?
(3) Is development of antibiotic resistance a concern? This could be an issue in a nursing home, hospice or hospital.
Administering an antibiotic near the end of life:
(1) often does not prolong life
(2) may be a burden to the patient
(3) may encourage emergence of antibiotic resistance to the antibiotics
In addition to risk factors mentioned in the paper, the following might be added:
(4) Are you administering the antibiotic just so that you feel like you are doing something?
If in doubt the problem can be discussed with family, designated decision maker and/or colleagues.
