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Antimicrobial use at the end of life: a scoping review
  1. Jack Fairweather1,
  2. Lesley Cooper2,
  3. Jacqueline Sneddon2 and
  4. R Andrew Seaton3
  1. 1University Hospital Monklands, Airdrie, Scotland
  2. 2Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland Glasgow, Glasgow, UK
  3. 3Queen Elizabeth University Hospital, Glasgow, UK
  1. Correspondence to Dr Lesley Cooper, Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland Glasgow, Glasgow, UK; lesley.cooper17{at}nhs.net

Abstract

Objective To examine antibiotic use in patients approaching end of life, in terms of frequency of prescription, aim of treatment, beneficial and adverse effects and contribution to the development of antimicrobial resistance.

Design Scoping review

Data sources An information scientist searched Ovid MEDLINE, Ovid EMBASE, The Cochrane library, PubMed Clinical Queries, NHS Evidence, Epistemonikos, SIGN, NICE, Google Scholar from inception to February 2019 for any study design including, but not limited to, randomised clinical trials, prospective interventional or observational studies, retrospective studies and qualitative studies. The search of Ovid MEDLINE was updated on the 10 June 2020.

Study selection Studies reporting antibiotic use in patients approaching end of life in any setting and clinicians’ attitudes and behaviour in relation to antibiotic prescribing in this population

Data extraction Two reviewers screened studies for eligibility; two reviewers extracted data from included studies. Data were analysed to describe antibiotic prescribing patterns across different patient populations, the benefits and adverse effects (for individual patients and wider society), the rationale for decision making and clinicians behaviours and attitudes to treatment with antibiotics in this patient group.

Results Eighty-eight studies were included. Definition of the end of life is highly variable as is use of antibiotics in patients approaching end of life. Prescribing decisions are influenced by patient age, primary diagnosis, care setting and therapy goals, although patients’ preferences are not always documented or adhered to. Urinary and lower respiratory tract infections are the most commonly reported indications with outcomes in terms of symptom control and survival variably reported. Small numbers of studies reported on adverse events and antimicrobial resistance. Clinicians sometimes feel uncomfortable discussing antibiotic treatment at end of life and would benefit from guidelines to direct care.

Conclusions Use of antibiotics in patients approaching the end of life is common although there is significant variation in practice. There are a myriad of intertwined biological, ethical, social, medicolegal and clinical issues associated with the topic.

  • drug administration
  • end of life care
  • home care
  • hospice care
  • hospital care
  • nursing home care

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Footnotes

  • Contributors JF, JS and RAS conceived the study and its design, JF and LC reviewed searches, extracted data and conducted data analysis. LC, JF, JS and RAS drafted and critically revised the manuscript and approved the submitted manuscript.

  • Funding JF was funded by the Royal College of Physicians and Surgeons of Glasgow for undertaking this work as part of a Scottish Clinical Leadership Fellowship focused on antimicrobial stewardship across several areas of practice including end-of-life care.

  • Competing interests LC, JS and RAS contributions to this work were undertaken as part of their roles in the Scottish Antimicrobial Prescribing Group. (SAPG is funded by the Scottish Government).

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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