Infections in Hospice Patients: When to Treat with Antibiotics
Hospice patients are at high risk for infections due to their underlying disease, poor nutritional state, and medications like steroids. Not only is the prevalence high, but the type of infection can vary. Studies have shown that symptom control may be the best objective when making decisions to start antibiotics. It’s tricky sometimes when trying to discern whether antibiotics will provide relief or whether they will cause additional burdens of treatment.
Infections in Hospice Patients
The main infections we see in our hospice patients are urinary tract, oral, respiratory tract, skin, and bacteremia. Antimicrobials improve symptoms in a large majority of patients with a urinary tract infection but are much less successful in respiratory and skin infections1, with bacteremia being the poorest controlled by antibiotics.
When to Treat Infections in Hospice Patients
This should be very individualized for each patient. The hospice care team must assess the desires of the patient, symptom control goals, and quality of life as well as weigh the benefits against the potential toxicities. Symptom control should be the main consideration for the use of antibiotics with hospice patients.
Conversations around antibiotic use are important to have with the patient and family prior to admission. These conversations about the treatment of infections are just as important as conversations about advance care directives, CPR, and ventilator use. These conversations help us establish our goals of treatment should an infection arise.
Patients with dementia are complicated because infections and fever account for a quarter of all treatment decisions and can be terminal events. With these patients, it’s important to understand the likelihood of increased frequency/severity of infections as a natural part of the dying process from dementia rather than as something distinct from dementia.
Communication is key to increasing understanding about disease trajectory and expectations.
DiGi Graham, Doctor of Pharmacy
Chief Corporate Pharmacist
Crossroads Hospice & Palliative Care
Crossroads Hospice & Palliative Care provides support to patients and families facing terminal illness. To learn more about our services, please call 1-888-564-3405.
References:
- Bruera, E., Higginson, I., Von Gunten, C. F., & Morita, T. (2015). Textbook of Palliative Medicine and Supportive Care, Boca Raton: CRC Press.
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