Antimicrobials at End of Life

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A recent article published in JAMA states that nearly 90% of patients with advanced cancer are prescribed an antimicrobial within the last week of life and 42% of patients with end-stage dementia during their final 2 weeks of life. Many of these patients reside in nursing homes with comfort as the intended goal.

According to the Centers for Disease Control and Prevention (CDC), each year up to 70% of nursing home residents receive one or more courses of antimicrobials for various infections, yet up to 75% of those prescriptions are given unnecessarily or incorrectly.  Subsequent postings online in The Wall Street Journal and USA Today provide additional discussion on the need to reduce antimicrobial misuse.  Patients may be prescribed antibiotics in the absence of clinical symptoms of infection as prescribers are usually not at the bedside to assess in home hospice and in nursing homes. There are also misconceptions that antibiotics are benign  compared to other life-prolonging interventions such as intubation and dialysis.

The CDC targeted efforts to reduce inappropriate antimicrobial prescribing in hospitals last year and is now focused on nursing homes. Adverse outcomes include cost of therapy, drug reactions, and drug-drug interactions.  More importantly, antimicrobial misuse promotes the growth of drug-resistant organisms (“super bugs”) such as Clostridium difficile, an infection that leads to 250,000 hospital admissions and 15,000 deaths every year. Infection management counseling in advance care planning for caregivers and infection control training for healthcare professionals have proven to combat misuse.

References:

Link to JAMA (10/1/2015)

The Wall Street Journal (10/12/2015)

USA Today (10/18/2015)

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