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Published on: August 30, 2018
Common Antimicrobial Treatment Considerations for Patients Receiving Comfort-Focused Care: What the Hospice Provider
Patrick D Crowley1, Leslie R Siegel2,3, Drew T Dickinson1,3
1Mayo Clinic, Division of Public Health, Infectious Disease, and Occupational Medicine, Rochester, Minnesota, USA.
Abstract:
Antimicrobials are used in the final few months of life in an attempt to palliate symptoms or treat potentially reversible infections. Antimicrobials cause side effects such as nausea, diarrhea, rash, and allergic reactions. Clinicians should select the narrowest and shortest treatment duration appropriate to the infection. Here, we present common oral antimicrobial agents used at the end of life, highlighting microbial coverage and important prescribing considerations. Providers should be aware of the limitations of antimicrobial treatment for patients at the end of life, particularly those enrolled in hospice, to inform discussions with patients and their families. This will allow tailoring of treatment to the patient's clinical situation and wishes.
Insights
Antimicrobials may be used at the end of life for symptom relief or reversible infections. Careful selection of narrow-spectrum, short-duration antimicrobials is crucial, considering patient wishes and potential side effects.
Area of Science:
- Geriatrics
- Palliative Care
- Infectious Diseases
Background:
- Antimicrobials are frequently prescribed in the final months of life.
- Treatment aims to palliate symptoms or manage potentially reversible infections.
Purpose of the Study:
- To review common oral antimicrobial agents used in end-of-life care.
- To highlight microbial coverage and key prescribing considerations for clinicians.
- To inform discussions regarding antimicrobial limitations and patient preferences.
Main Methods:
- Review of common oral antimicrobial agents.
- Discussion of microbial coverage.
- Consideration of prescribing factors at the end of life.
Main Results:
- Antimicrobial use at end of life presents challenges and potential side effects.
- Narrowest and shortest effective treatment durations are recommended.
- Understanding limitations is key for informed patient-family discussions.
Conclusions:
- Antimicrobial therapy at the end of life requires careful consideration of benefits, risks, and patient goals.
- Tailoring treatment to the individual's clinical status and wishes is paramount.
- Awareness of antimicrobial limitations is essential for providers, especially for hospice patients.
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