Skip to main content

Advertisement

SpringerLink
Log in

Antimicrobial therapy in palliative care: an overview

  • Review Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

In the advanced stages of illness, patients often face challenging decisions regarding their treatment and overall medical care. Terminal ill patients are commonly affected by infections. However, in palliative care, the use of antimicrobials can be an ethical dilemma. Deciding whether to treat, withhold, or withdraw the antimicrobial treatment for an infection can be difficult. Antimicrobial administration can lead to adverse outcomes but the two main benefits, longer survival and symptom relief, are the main reasons why physicians prescribe antimicrobial when treating terminally ill patients. For the patient who has an irreversible advanced heart or lung disease, or an advanced dementia, or a metastatic cancer, it is easier the decision of withholding mechanical ventilation, tube feeding, and dialysis than antibiotherapy. To characterize infections, agents, and their treatments in palliative care, we conducted a review of the literature. We also included some tips to help health professionals to guide their clinical approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. World Health Organization (2002). National cancer control programmes: policies and managerial guidelines. http://apps.who.int/iris/bitstream/10665/42494/1/9241545577.pdf. Accessed 13 April 2016

  2. DeVita V, Hellman S, Rosenberg S (2001). Cancer principles and practice of oncology, Sixth edition. Lippincott, Williams.

  3. Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, Moore M, Rydall A, Rodin G, Tannock I, Donner A, Lo C (2014) Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet 383:1721–1730

    Article  PubMed  Google Scholar 

  4. Gaertner J, Weingärtner V, Wolf J, Voltz R (2013) Early palliative care for patients with advanced cancer: how to make it work? Curr Opin Oncol 25:342–352

    PubMed  Google Scholar 

  5. Chochinov H (2002) Dignity-conserving care a new model for palliative care: helping the patient feel valued. JAMA 287:2253–2260

    Article  PubMed  Google Scholar 

  6. Schofield P, Carey M, Love A, Nehill C, Wein S (2006) ‘Would you like to talk about your future treatment options?’ discussing the transition from curative cancer treatment to palliative care. Palliat Med 20(4):397–406

    Article  PubMed  Google Scholar 

  7. Juthani-Mehta M, Malani P, Mitchell S (2015) Antimicrobials at the end of life: an opportunity to improve palliative care and infection management. JAMA 314(19):2017–2018

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Ahronheim J, Morrison R, Baskin S, Morris J, Meier DE (1996) Treatment of the dying in the acute care hospital. Arch Intern Med 156:2094–2100

    Article  CAS  PubMed  Google Scholar 

  9. Goodlin S, Winzeberg G, Teno J et al (1998) Death in the hospital. Arch Intern Med 158:1570–1572

    Article  CAS  PubMed  Google Scholar 

  10. Pereira J, Watanabe S, Wolch G (1998) A retrospective review of the frequency of infections and patterns of antibiotic utilization on a palliative care unit. J Pain Symptom Manag 16(6):374–381

    Article  CAS  Google Scholar 

  11. Lagman R, Panta R, Walsh D (1996) Infectious complications in advanced cancer. Support Care Cancer 4:226

    Google Scholar 

  12. Nagy-Agren S, Haley H (2002) Management of infections in palliative care patients with advanced cancer. J Pain Symptom Manag 24(1):64–70

    Article  Google Scholar 

  13. Glauser M, Zinner S (1982) Mechanisms of acquisition and development of bacterial infections in cancer patients. Raven Press, New York, pp 13–24

    Google Scholar 

  14. Vitetta L, Kenner D, Sali A (2000) Bacterial infections in terminally ill hospice patients. J Pain Symptom Manag 20(5):326–334

    Article  CAS  Google Scholar 

  15. Marcus E, Clarfield A, Moses A (2001) Ethical issues relating to the use of antimicrobial therapy in older adults. Clin Infect Dis 33(10):1697–1705

    Article  CAS  PubMed  Google Scholar 

  16. Thompson A, Silveira M, Vitale C, Malani P (2012) Antimicrobial use at the end of life among hospitalized patients with advanced cancer. Am J Hosp Palliat Care 29(8):599–603

    Article  PubMed  Google Scholar 

  17. Albrecht J, McGregor J, Fromme E et al (2013) A nationwide analysis of antibiotic use in hospice care in the final week of life. J Pain Symptom Manag 46(4):483–490

    Article  Google Scholar 

  18. Evers M, Purohit D, Perl D et al (2002) Palliative and aggressive end-of-life care for patients with dementia. Psychiatr Serv 53(5):609–613

    Article  PubMed  Google Scholar 

  19. Yao C, Hsieh M, Chiu T et al (2015) Wishes of patients with terminal cancer and influencing factors toward the use of antibiotics in Taiwan. Am J Hosp Palliat Care 32(5):537–543

    Article  PubMed  Google Scholar 

  20. White P, Kuhlenschmidt H, Vancura B, Navari R (2003) Antimicrobial use in patients with advanced cancer receiving hospice care. J Pain Symptom Manag 25(5):438–443

    Article  Google Scholar 

  21. Stiel S, Krumm N, Pestinger M, Lindena G, Nauck F, Ostgathe C, Radbruch L, Elsner F (2012) Antibiotics in palliative medicine-results from a prospective epidemiological investigation from the HOPE survey. Support Care Cancer 20(2):325–333

    Article  PubMed  Google Scholar 

  22. Clayton J, Fardell B, Hutton-Potts J, Webb D, Chye R (2003) Parenteral antibiotics in a palliative care unit: prospective analysis of current practice. Palliat Med 17(1):44–48

    Article  PubMed  Google Scholar 

  23. Reinbolt R, Shenk A, White P, Navari R (2005) Symptomatic treatment of infections in patients with advanced cancer receiving hospice care. J Pain Symptom Manag 30(2):175–182

    Article  Google Scholar 

  24. Brown N, Thompson D (1979) Nontreatment of fever in extended-care facilities. N Engl J Med 300:1246–1250

    Article  CAS  PubMed  Google Scholar 

  25. Fabiszewski K, Volicer B, Volicer L (1990) Effect of antibiotic treatment on outcome of fevers in institutionalized Alzheimer patients. JAMA 263:3168–3172

    Article  CAS  PubMed  Google Scholar 

  26. Chen L, Chou Y, Hsu P et al (2002) Antibiotic prescription for fever episodes in hospice patients. Support Care Cancer 10(7):538–541

    Article  PubMed  Google Scholar 

  27. Robinson G, Tegtmeier B, Zaia J (1984) Brief report: nosocomial infection rates in a cancer treatment center. Infect Control 5:289–294

    Article  CAS  PubMed  Google Scholar 

  28. Kuehn N, MacEachern T, Miller M, Spachynski K (1992) Nosocomial infections (NI) on a palliative care unit (PCU): a prospective comparison study. In: Poster for 9th international congress on Care of the Terminally ill. Canada, Montreal

    Google Scholar 

  29. Homsi J, Walsh D, Panta R et al (2000) Infectious complications of advanced cancer. Support Care Cancer 8(6):487–492

    CAS  PubMed  Google Scholar 

  30. Beckers M, Ruven H, Seldenrijk C et al (2010) Risk of thrombosis and infections of central venous catheters and totally implanted access ports in patients treated for cancer. Thromb Res 125(4):318–321

    Article  CAS  PubMed  Google Scholar 

  31. Narducci F, Jean-Laurent M, Boulanger L et al (2011) Totally implantable venous access port systems and risk factors for complications: a one-year prospective study in a cancer centre. Eur J Surg Oncol 37(10):913–918

    Article  CAS  PubMed  Google Scholar 

  32. Becton D, Kletzel M, Golladay E et al (1988) An experience with an implanted port system in 66 children with cancer. Cancer 61(2):376–378

    Article  CAS  PubMed  Google Scholar 

  33. Winters V, Peters B, Coilá S, Jones L (1990) A trial with a new peripheral implanted vascular access device. Oncol Nurs Forum 17(6):891–896

    CAS  PubMed  Google Scholar 

  34. McNelis J, Zarcone J, Marini C, Jurkiewicz A (2002) Outcome of subcutaneously implanted catheters in a teaching hospital. Am J Med Qual 17(5):185–188

    Article  PubMed  Google Scholar 

  35. Rotstein C, Cummings K, Nicolaou A et al (1988) Nosocomial infection rates at an oncology center. Infect Control Hosp Epidemiol 9(1):13–19

    Article  PubMed  Google Scholar 

  36. Bentley D, Bradley S, High K et al (2001) Practice guideline for evaluation of fever and infection in long-term care facilities. J Am Geriatr Soc 49(2):210–222

    Article  CAS  PubMed  Google Scholar 

  37. High K, Bradley S, Gravenstein S et al (2009) Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the infectious diseases society of America. Clin Infect Dis 48(2):149–171

    Article  PubMed  Google Scholar 

  38. McGeer A, Campbell B, Emori T et al (1991) Definitions of infection for surveillance in long-term care facilities. Am J Infect Control 19:1–7

    Article  CAS  PubMed  Google Scholar 

  39. Yoshikawa TT, Norman DC (1987) Diagnostic approach to infections. Igaku-Shoin, New York, pp 26–31

    Google Scholar 

  40. Wasserman M, Levinstein M, Keller E et al (1989) Utility of fever, white blood cells, and differential count in predicting bacterial infections in the elderly. J Am Geriatr Soc 37:537–543

    Article  CAS  PubMed  Google Scholar 

  41. Nicolle LE (1993) Urinary tract infections in long-term care facilities. Infect Control Hosp Epidemiol 14:220–225

    Article  CAS  PubMed  Google Scholar 

  42. Muder R, Brennen C, Wagener M, Goetz A (1992) Bacteremia in a long-term care facility: a five-year prospective study of 163 consecutive episodes. Clin Infect Dis 14:647–654

    Article  CAS  PubMed  Google Scholar 

  43. Green K, Webster H, Watanabe S, Fainsinger R (1994) Management of nosocomial respiratory tract infections in terminally ill cancer patients. J Palliative Care 10(4):31–34

    CAS  Google Scholar 

  44. Bolayirli M, Turna H, Orhanoğlu T et al (2007) C-reactive protein as an acute phase protein in cancer patients. Med Oncol 24(3):338–344

    Article  CAS  PubMed  Google Scholar 

  45. Sedef A, Kose F, Mertsoylu H, Ozyilkan O (2015) Procalcitonin as a biomarker for infection-related mortality in cancer patients. Curr Opin Support Palliat Care 9(2):168–173

    Article  PubMed  Google Scholar 

  46. Shomali W, Hachem R, Chaftari A et al (2012) Can procalcitonin distinguish infectious fever from tumor-related fever in non-neutropenic cancer patients? Cancer 118(23):5823–5829

    Article  CAS  PubMed  Google Scholar 

  47. Miller D (1994) Withholding antibiotics as a form of care: an ethical perspective. Springer, New York, pp 283–298

    Google Scholar 

  48. MacKey J, Birchall I, MacDonald N (1995) Occult infection as a cause of hip pain in a patient with metastatic breast cancer. J Pain Symptom Manag 10(7):569–572

    Article  CAS  Google Scholar 

  49. Reilly R, Teasdale T, McCullough L (1994) Projecting patients’ preferences from living wills: an invalid strategy for management of dementia with life-threatening illness. J Am Geriatr Soc 42:997–1003

    Article  CAS  PubMed  Google Scholar 

  50. Schrijvers D, Cherny N (2014) ESMO clinical practice guidelines on palliative care: advanced care planning. Ann Oncol 25(suppl 3):iii138–iii142

    Article  PubMed  Google Scholar 

  51. Hirsh J, Hoak J (1996) Management of deep vein thrombosis and pulmonary embolism. A statement for healthcare professionals. Council on thrombosis (in consultation with the council on cardiovascular radiology), American Heart Association. Circulation 93(12):2212–2245

    Article  CAS  PubMed  Google Scholar 

  52. Kröger K, Weiland D, Ose C et al (2006) Risk factors for venous thromboembolic events in cancer patients. Ann Oncol 17(2):297–303

    Article  PubMed  Google Scholar 

  53. Stein P, Willis P, DeMets D et al (1981) History and physical examination in acute pulmonary embolism in patients without preexisting cardiac or pulmonary disease. Am J Cardiol 47:218–223

    Article  CAS  PubMed  Google Scholar 

  54. Stein P, Afzal A, Henry J, Villareal C (2000) Fever in acute pulmonary embolism. Chest 117(1):39–42

    Article  CAS  PubMed  Google Scholar 

  55. Prigerson H, Bao Y, Shah M et al (2015) Chemotherapy use, performance status, and quality of life at the end of life. JAMA Oncol 1(6):778–784

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Portuguese Oncology Institute of Coimbra, Coimbra, Portugal

    Filipa Macedo, Nadine Saraiva & Nuno Bonito

  2. Braga Hospital, Braga, Portugal

    Catarina Nunes, Katia Ladeira, Filipa Pinho, Luísa Pinto & Francisco Gonçalves

Authors
  1. Filipa Macedo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Catarina Nunes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katia Ladeira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Filipa Pinho
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nadine Saraiva
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nuno Bonito
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luísa Pinto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Francisco Gonçalves
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Filipa Macedo.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Macedo, F., Nunes, C., Ladeira, K. et al. Antimicrobial therapy in palliative care: an overview. Support Care Cancer 26, 1361–1367 (2018). https://doi.org/10.1007/s00520-018-4090-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-018-4090-8

Keywords

Search

Navigation