Antimicrobials in palliative care- comfort or cure?

Guest post from Dr Hema Varadhan, Staff Specialist Microbiology:

The focus of palliative care is to provide comfort for patients in their final stages of life. The use of medication should aim to provide this comfort by controlling troubling symptoms. So what role to antimicrobials have, if the intention is not curative?

Research suggests that antimicrobials are commonly prescribed to dying patients in the absence of adequate clinical symptoms to support a bacterial infection.  According to a study by Thompson et al , one quarter of  hospitalised patients whose goal of therapy was  comfort care received antimicrobials during the week prior to death. This is due to antimicrobials being seen much less burdensome than other invasive interventions like intubation, dialysis etc.

In an article by Mehta et al  published in the Journal of the American Medical Association Nov 2015, the authors address the need for further guidelines and stewardship in this group of patients. One of the possible approaches include  evidence based- goal directed counselling about infection management at the end of life planning and discussions.  Perhaps this effort should be a collaborative approach including the palliating team, infectious diseases personnel and the family where relevant.

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