Reducing antibiotic use for terminally ill patients

Antimicrobial use is common in patients with terminal cancer because of the concern for infection due to severe immunocompromise; moreover, various complications frequently mimic infection. However, despite conferring no survival advantage, antibiotic use in these end-stage patients contributes to adverse drug reactions, Clostridioides difficile infection, and antimicrobial resistance.

A study was conducted on 1,143 adult patients who died of metastatic cancer after ≥4 days of hospitalisation at an academic hospital in Seoul, Korea. It was found that antibiotics were administered in 82% of patients within 3 days of death. The proportion of patients receiving antibiotics was lower in the palliative care group than in the non palliative care group..

While rarely addressed in the context of antimicrobial stewardship, minimising antibiotic prescribing at or near the end of life seems logical for improving individual patients' quality of life while also reducing selection pressure that generates multidrug-resistant pathogens. This topic should no longer be the "elephant in the room" when talking about the right way to use antibiotics.