End of Life Infection Care

A lot of patients in the final stages of life face complicated decisions on their medical care and what should be treated. Infections are one of the most prevalent complications that these patients experience. A lot of clinicians prescribe antimicrobials in the weeks leading up to death. According to the article, 90% of cancer patients are prescribed these medications during the week prior to death. There are risks and benefits associated with prescribing antimicrobials to these patients when they are so close to death. Risks include drug reactions and interactions, the burden of treating more symptoms when the patient is terminally ill, and contributing to drug resistance. However, these medications can contribute to prolonged survival and symptom relief.

I think pharmacists can have a huge impact in these type of situations. Pharmacists, in my opinion, may be the best suited for these decisions and can help physicians make an informed decision. Will this drug be effective enough in relieving symptoms compared to the risks it poses to the patient? Do these medications interact with any treatment the patient is currently on? Pharmacists can weigh the risks and benefits of all of these questions and help other clinicians make informed decisions. This is an excellent article in showing how pharmacists need to be part of the health care team.

JAMA. 2015;314(19):2017-2018

3 thoughts on “End of Life Infection Care”

  1. I believe this is an extremely interesting topic because end of life care is something that has been a popular discussion recently. In patients with terminal illnesses and a limited life expectancy, what is the best decision: a comfortable remainder of life or a faster escape from the pain? That is ultimately up to the patient, but when medications are put into play, pharmacists definitely need to help patients and physicians make this decision. They are the medication experts, and can take what a patient decides what they want out of the little time they have left, and provide that to the patient in the safest and most effective method possible. Pharmaceutical care does not stop when a patient reaches a certain stage of their illness, rather the goals of care change, which is why I think it’s so important for the health care team to see the value of pharmacists in all situations.

  2. I found this article very interesting in part because I have never heard of using antimicrobials in cancer patients or hospice recipients and also because it appears that not much research has been done concerning their efficacy. Although antimicrobials seem to be widely prescribed by physicians, the article claims, “No randomized trials have been conducted examining these outcomes in this population.” This leads me to question why a treatment that has no solid proof of its efficacy is prescribed to 90% of hospitalized patients with advanced cancer. The article further claims that no study has reported survival rates of patients with various terminal illnesses who did and did not receive antimicrobial treatment. It is difficult for me to understand why this treatment has become so widely used by health care professionals even though no proof exists that it will actually help the patient. Is this decision only being made by the physician or the entire health care team? I feel as though pharmacists should work together with the rest of the patient’s health care team to decide if antimicrobial treatment is appropriate. They are most knowledgeable about potential drug-drug interactions and are best able to assess potential side effects/health risks that come with taking antimicrobials.

  3. This article reminded me of Dr. Pruskowski. She works at the clinical practice site at University of Pittsburgh Medical Center Palliative Supportive Institute as the Palliative Care Clinical Pharmacy Specialist. The one most important thing I remembered from her was that deprescribing is just as important as prescribing. Sometimes it is better to deprescribe geriatric patients than to prescribe them. These patients sometimes feel much better after they are off their medications.

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