The use of antibiotics is so engrained in contemporary
medicine that 21 percent of patients being discharged from hospitals directly
to a hospice program leave with a prescription for antibiotics, even though
more than one fourth of them don’t have a documented infection during their
hospital admission.
About 27 percent of hospice patients are still taking
antibiotics in the final week of their life.
This raises serious questions about whether such broad and
continued antibiotic use is appropriate in so many hospice cases, experts say,
where the underlying concept is to control pain and protect the remaining
quality of life without aggressively continuing medical treatment.
Additional concerns with antibiotic use, the study
concluded, include medication side effects and adverse events, increased risk
of subsequent opportunistic infections, prolonging the dying process and
increasing the risk of developing antibiotic resistant microorganisms.
The findings were just published in Antimicrobial Agents and
Chemotherapy by researchers from Oregon State University and the Oregon Health
& Science University. It was supported by the National Institutes of
Health.
“Hospice care is very patient centered and in terminal
patients it focuses on palliative care and symptom relief, not curative
therapy,” said Jon Furuno, an associate professor in the Oregon State
University/Oregon Health & Science University College of Pharmacy.
“It’s not for everyone, and it’s a serious decision people
usually make in consultation with their family, nurses and doctors. These are
tough conversations to have.
“Having decided to use hospice, however, the frequency and
prevalence of antibiotic use in this patient population is a concern,” Furuno
said. “Antibiotics themselves can have serious side effects that sometimes
cause new problems, a factor that often isn’t adequately considered. And in
terminally-ill people they may or may not work anyway.”
Issues such as this, Furuno said, continue to crop up in the
evolving issue of hospice care, which is still growing in popularity as many
people choose to naturally allow their life to end with limited medical
treatment and often in their own homes. Hospice is covered by Medicare for people
with a life expectancy of less than six months, helps to control medical costs
and reduce hospital stays, and its services are now used by more than one third
of dying Americans.
Unnecessary and inappropriate antibiotic use is already a
concern across all segments of society, researchers said in the report, and
more efforts are clearly needed to address the issue in hospice patients. The
design of the study probably leads to it underestimating the significance of
the problem, the researchers wrote in their conclusion.
