A 2026 systematic review by Alzahrani et al., published in the American Journal of Hospice and Palliative Medicine, finds that antibiotics prescribed near the end of life often deliver inconsistent symptom relief while adding substantial treatment burden. The review notes that antibiotic use remains common across hospice, hospital, community and long‑term care settings, and is frequently given even when an infection has not been clearly confirmed. Overall, the evidence suggests benefits are uneven and depend on the type of infection: roughly half of patients with sepsis reported symptom improvement, whereas response rates were much lower for urinary tract infections (about 17%) and even less reliable for respiratory infections or infections without a clear source.
The authors emphasize that antibiotic therapy cannot be treated as a uniform comfort measure. Sepsis-an overwhelming, body‑wide response to infection-appears most likely to yield symptomatic benefit, probably because it can rapidly worsen systemic symptoms. By contrast, localized infections such as urinary tract infections and many respiratory problems rarely produce consistent relief from antibiotics alone, especially in the final weeks of life. Those distinctions matter when goals of care shift toward comfort rather than life‑prolonging interventions.
Treatment harms are an important counterweight to any potential gain. The review highlights adverse drug effects, pain and complications from intravenous access, burdens of hospital transfer, and the population‑level risk of increasing antimicrobial resistance. For patients focused on symptom control and quality of life, these physical and logistical burdens can outweigh small or uncertain benefits.
The paper calls for tighter antimicrobial stewardship and explicit shared decision making. Clinicians are advised to discuss likely symptom benefit, possible harms, and patient goals before prescribing, and to avoid automatic antibiotic use. The practical takeaway is clear: align antibiotic decisions with individual goals of care, use antimicrobials selectively when symptom relief is plausible, and prioritize patient‑centered outcomes over routine prescribing (Alzahrani M et al., Am J Hosp Palliat Med. 2026; doi:10.1177/10499091261447384).
Original Source: https://www.emjreviews.com/microbiology-infectious-diseases/news/antibiotic-use-at-the-end-of-life-questioned/
Category:
Tags:
Publish Date: 2026-04-23 13:47:00
