Parenteral antibiotics in a palliative care unit: prospective analysis of current practice

Abstract

All patients receiving parenteral antibiotics in a palliative care unit were prospectively monitored over a 13-month period. Of 913 consecutive admissions, 41 patients received 43 courses of parenteral antibiotics. On 27 of 43 occasions, the use of parenteral antibiotics was considered helpful (62%), in eight cases it was considered unhelpful (19%) and in a further eight cases the outcome could not be assessed (19%). The sites of infection for which parenteral antibiotics were prescribed included urinary tract infections (37%), lower respiratory tract infections (26%), soft tissue/skin or wound infections (16%), purulent terminal respiratory secretions (5%) and other (16%). In this sample, urinary tract infections were more commonly associated with a positive outcome than other indications combined (88% versus 48%, respectively). There appeared to be no association between outcome of use and age of the patient (median age 70, range 37-90), underlying diagnosis (HIV versus advanced malignancy) and reason for admission (symptom control versus respite care versus terminal care). However, outcomes appeared to vary in this sample according to the palliative care phase of the patient at the time parenteral antibiotics were administered. Positive outcomes were more common in terminal- (83%) and stable-phase (71 %) patients than deteriorating- (58%) or acute-phase (38%) patients. This survey demonstrates that in specific circumstances a beneficial role exists for the use of parenteral antibiotics in a palliative care setting. The establishment of appropriate guidelines is recommended.

Does palliative care improve outcomes for patients with HIV/AIDS? A systematic review of the evidence

“…For example, one study 49 reported palliative care consultations in an acute care hospital where only 8.3% of patients had HIV disease, a second study of the benefits of symptom control by a hospital based palliative care consultant and pharmacist also had only 8% of patients with HIV, 50 and a third study of parenteral antibiotics in an inpatient palliative care unit reported 15% of patients having an underlying HIV diagnosis. 51 The potential for a selection bias in HIV palliative care evaluation was demonstrated in a study that found patients reported lower levels of pain, better insight, less anxiety, and fewer spiritual problems than in providers' assessments. 24 Patient self reports are also subject to bias because of more unwell patients being unable or unwilling to participate.…”

Antimicrobial Use for Symptom Management in Patients Receiving Hospice and Palliative Care: A Systematic Review

“…For three studies, we recalculated the proportion of patients in whom symptom improvement was observed to generate measures of effect comparable to that of the other studies. [6][7][8] We calculated 95% confidence intervals for sample proportions using the exact binomial method to provide precision of estimation.…”

Feasibility of subcutaneous antibiotics for palliative care patients

“…Antibiotic therapy for the management of neutropenia and non-neutropenic haematologic diseases has been widely described and is regularly updated. However, there is little information regarding the management of antibiotic therapy in palliative care patients [4][5][6][7].…”

“…As palliative care focuses on relieving and preventing suffering and improving quality of life, treatment choices should be made based on symptom improvement and control. Antibiotic treatment might be considered part of a good palliative care plan in the presence of life-threatening infections, but the decision to treat can also lead to burdens due to diagnostic tests, adverse reactions to antibiotics or the use of intravenous lines [7]. Other aspects, such as patient and family wishes, the patient's overall condition and prognosis, and the potential for symptom control, must also be considered [3,[7][8].…”

“…In palliative care the oral route of administration is advocated as the first choice for the treatment of symptoms [1,[6][7]. However, there are certain situations where this is impossible (gastric intolerance, swallowing disorders, persistent nausea and vomiting, intolerance to oral administration of opioids, malabsorption, extreme weakness, delirium, severe pain) and an alternative route is required [9].…”