In the Journals Plus

Study: Antimicrobials commonly prescribed for dying patients despite limited efficacy

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August 16, 2018

Although they have little effect, antimicrobials are commonly prescribed for dying patients in the last 2 weeks of life — a practice that should be reconsidered to improve end-of-life care, researchers wrote recently in Infection Control & Hospital Epidemiology.

“Significant debate is underway regarding whether antimicrobial use is a desirable treatment option for patients with an advanced- or terminal-stage illness,” Yasuaki Tagashira, MD, and colleagues from the division of infectious diseases at Tokyo Metropolitan Tama Medical Center, wrote. “Unnecessary or inappropriate antimicrobial therapy at the end of life may produce an array of undesirable results, including the prolongation of the dying process, the emergence of multidrug-resistant organisms, and a financial burden on the health care system.”

To investigate antimicrobial use in these situations, Tagashira and colleagues screened patients who died at the Tokyo Metropolitan Tama Medical Center in 2016. They included 260 patients who were hospitalized with an advance-stage illness and later died at the institution.

Among them, 192 had an advanced-stage malignancy and 136 were given antimicrobials in the last 14 days of their life, including 60 who received antimicrobial therapy for symptom relief.

The researchers explained that although symptom relief was a primary cause for antimicrobial use, relief may not be achievable by antimicrobial therapy alone.

Only 23% of the patients who received antimicrobial therapy experienced symptom relief, according to the study.

With approximately half of the hospitalized patients receiving antimicrobial treatment in the last 14 days of life, Tagashia and colleagues said it is time to reconsider antimicrobial use to avoid resistance and overuse.

In a similar study conducted at the Children’s Hospital of Philadelphia and the University of Pennsylvania, researchers polled both adult and pediatric physicians on whether or not they believed that antimicrobial use in end-of-life care contributes to antibiotic resistance. Only 49.8% said it did, including the majority of adult care physicians. The study also reported that 86.2% of participants believed it was important to respect a patient’s desire to continue antimicrobial use, regardless of its effectiveness. The researchers identified several rationales for continuing antimicrobial treatment in dying patients, including a desire to avoid the appearance that they were giving up on the patient, uncertainty of whether the patient was actually nearing death, and a desire to reduce the patient’s suffering.

Hitoshia Honda, MD, PhD, a co-author of the current study, told Infectious Disease News that antimicrobial use must be judicious and well balanced for patients’ improvement.

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“I think a certain amount of antimicrobials are used in the end-of-life care despite limited efficacy and the current practice has to be reconsidered given the threat of antimicrobial resistance, which is likely associated with the overuse of antimicrobials,” Honda said. “We should be more aware that the therapy we are providing may not always be effective, and antimicrobials do not even achieve symptom relief for end-of-life patients. I think other treatment options, including advanced care planning for end-of-life illness [and] advancing other palliative care are more important than just giving antimicrobials in order to achieve patient-centered outcome or quality of care.” – by Caitlyn Stulpin

Disclosures: The authors report no relevant financial disclosures.