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Featured Clinical Reviews

November 17, 2015

Antimicrobials at the End of Life: An Opportunity to Improve Palliative Care and Infection Management

Author Affiliations
  • 1Yale School of Medicine, Section of Infectious Diseases, Department of Internal Medicine, New Haven, Connecticut
  • 2University of Michigan Health System, Division of Infectious Diseases, Department of Internal Medicine, Ann Arbor
  • 3Associate Editor, JAMA
  • 4Hebrew SeniorLife Institute for Aging Research, the Department of Medicine, Beth Israel Deaconess Medicine Center, Boston, Massachusetts
  • 5Department of Medicine, Harvard Medical School, Boston, Massachusetts
JAMA. 2015;314(19):2017-2018. doi:10.1001/jama.2015.13080

Patients in the final stage of an advanced illness often face challenging decisions about the direction of their overall medical care and treatment of specific complications that occur as the end of life approaches. Infections and febrile episodes are among the most common acute complications experienced by terminally ill patients.

Close to 90% of hospitalized patients with advanced cancer receive antimicrobials during the week prior to death,1 and 42% of nursing home residents with advanced dementia are prescribed antimicrobials during the last 2 weeks of life.2 Approximately one-quarter of hospice recipients, for whom the intended goal of care is comfort, receive antimicrobials during the final weeks of life.3,4 Research suggests that antimicrobials are commonly prescribed to dying patients in the absence of adequate clinical symptoms to support a bacterial infection.4,5 How decisions for suspected infections are made in these patients warrants increased scrutiny by clinicians, patients, and family members.

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