Design and analysis of longitudinal trials of antimicrobial use at the end of life: to give or not to give?

Juthani‐Mehta, Manisha; Allore, Heather G.

doi:10.1177/2042098618820210

Cited by 10 publications

(10 citation statements)

References 65 publications

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“…highlight the principles of research design and analyses in vulnerable populations that support the care process, as well as an assessment of the benefits that may well be attenuated compared with the general populations, in trial designs that do not burden patients already burdened by both illness and care. 15…”

Section: For the International Group For Reducing Inappropriate Medicmentioning

confidence: 99%

Foreword to the first special collection: Addressing the invisible iatrogenic epidemic: the role of deprescribing in polypharmacy and inappropriate medication use

Mangin

Garfinkel

2019

Therapeutic Advances in Drug Safety

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The role of de-prescribing in polypharmacy and inappropriate medication use For the International Group for Reducing Inappropriate Medication Use and Polypharmacy The issues around inappropriate medication use and polypharmacy (IMUP) for individual patients are well known: associations with harmful physical and psychological effects, negative implications for mobility and social interactions as well as the opportunity costs of the sheer burden of treatment. The effect of this problem at the population level is massive. Nearly one-half of older adults take five or more medications, and as many as one in five of these prescriptions is potentially inappropriate. 1,2 Older adults prescribed more medications are more likely to be hospitalized for an adverse drug reaction. 3 Moreover, adverse drug events account for more morbidity and mortality than most chronic diseases, 4,5 with death rates higher than many common cancers. 6,7 The prescribing cascade often attached to inappropriate medication use and polypharmacy drives overdiagnosis and overtreatment, escalating the cost of drugs and hospitalizations.

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Section: For the International Group For Reducing Inappropriate Medicmentioning

confidence: 99%

Foreword to the first special collection: Addressing the invisible iatrogenic epidemic: the role of deprescribing in polypharmacy and inappropriate medication use

Mangin

Garfinkel

2019

Therapeutic Advances in Drug Safety

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“…En el contexto actual de envejecimiento general de la población, la limitación del esfuerzo terapéutico en pacientes con expectativas de vida limitadas es una de las cuestiones pobremente exploradas en la literatura (97,98). Cuando el caso particular involucra al tratamiento antibiótico, ya sea su inicio o su continuación, el desafío es aún más importante, pues involucra el daño potencial al entorno, en vista del dramático escenario actual de resistencia a antimicrobianos, e implica una difícil toma de decisiones.…”

Section: ) Antibióticos Al Final De La Vidaunclassified

“…Buenos Aires. julio 2021. volumen 29. número 106:[85][86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101][102]…”

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12 pasos para reducir la incidencia de carbapenemasas

Clara¹,

Desse²,

Nuccetelli³

et al. 2021

ASEI

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La resistencia a los antimicrobianos es un grave problema para la salud mundial. Es aún más crítico en los hospitales debido a la aparición de bacterias Gram negativas resistentes a múltiples fármacos, asociadas a una alta mortalidad. Las opciones de tratamiento en estos casos son escasas, en general de alto costo. La alta densidad de consumo de antibióticos y la transmisión cruzada en este entorno amplifican este problema. Hay más evidencia del impacto de las medidas de control de infecciones que de las intervenciones de comités de antimicrobianos para mitigarlo. Además, pocos países cuentan con programas sólidos de control de infecciones para enfrentar este problema. En la presente revisión se propone una serie de 12 pasos a adoptar para mitigar la prevalencia de resistencia antimicrobiana y reducir la incidencia de carbapenemasas en las instituciones de salud. Estas recomendaciones deben interpretase como un ¨bundle¨ o paquete de medidas, en el cual todas son importantes. Aquellas que involucran la prevención de infecciones y/o colonizaciones y su diseminación son las de mayor impacto demostrado hasta ahora. Es esencial que los programas de optimización de uso de antimicrobianos cuenten con el empoderamiento de la conducción de las instituciones donde se lleven a cabo, así como también que estén constituidos por un equipo multidisciplinario eficiente, sólidamente entrenado, con metas y métricas objetivas y auditorias periódicas. También es recomendable que se incluyan recomendaciones para los tratamientos en pacientes en cuidados de fin de vida.

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“…Two theoretical bene ts motivate providers to prescribe antimicrobials to terminally ill patients; prolonging survival and relieving symptoms. However, limited data provide evidence regarding these outcomes [2]. In a recent editorial, Furuno et al argue that decisions on antibiotic use in hospice care should be made on a case-by-case basis and be consistent with the individuals' goals of care [3].…”

Section: Introductionmentioning

confidence: 99%

Antibiotic treatment in end stage cancer patients, its advantages and disadvantages

Tahmasebi

Hosamirudsari

Shirin

et al. 2022

Preprint

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Aim: In this study our aim was to elucidate whether advanced cancer patients benefit from antibiotic treatment in the last days of life in addition to reviewing the relevant costs and effects.Materials and methods: We reviewed medical records from 100 end-stage cancer patients that treated with antibiotics during the hospitalization in Imam Khomeini hospital. Patient's medical records were analyzed retrospectively for cause and periodicity of infections, fever, increase in acute phase proteins, cultures, type and cost of antibiotic. Results: Microorganisms were found in only 29 patients (29%) and the most microorganism among the patients was E.coli (6%). About 78% of the patients had clinical symptoms. The highest dose of antibiotics was related to Ceftriaxone (40.2%) and in the second place was Metronidazole (34.7%) and the lowest dose was related to Levofloxacin, Gentamycine and Colistine (1.4%). Fifty-one patients (71%) did not have any side effects due to antibiotics. The most common side effect of antibiotics among patients was skin rash (12.5%). The average estimated cost for antibiotic use was 7935540 Rials (24.4 dollars).Conclusion: Regardless of not prescribing antibiotics or the type of antibiotics used, it was ineffective in treating advanced cancer patients. The cost of using antibiotics during hospitalization is very high, and physicians should consider the risk of developing resistant hospital strains. Antibiotic side effects also occur in patients, causing more harm to the patient at the end of life.

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Design and analysis of longitudinal trials of antimicrobial use at the end of life: to give or not to give?

Cited by 10 publications

References 65 publications

Foreword to the first special collection: Addressing the invisible iatrogenic epidemic: the role of deprescribing in polypharmacy and inappropriate medication use

Foreword to the first special collection: Addressing the invisible iatrogenic epidemic: the role of deprescribing in polypharmacy and inappropriate medication use

12 pasos para reducir la incidencia de carbapenemasas

Antibiotic treatment in end stage cancer patients, its advantages and disadvantages

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