RT Journal Article SR Electronic T1 Antibiotic use towards the end of life: development of good practice recommendations JF BMJ Supportive & Palliative Care JO BMJ Support Palliat Care FD British Medical Journal Publishing Group SP bmjspcare-2020-002732 DO 10.1136/bmjspcare-2020-002732 A1 R Andrew Seaton A1 Lesley Cooper A1 Jack Fairweather A1 Stephen Fenning A1 Libby Ferguson A1 Susan Galbraith A1 Tony Duffy A1 Jacqueline Sneddon YR 2021 UL http://spcare.bmj.com/content/early/2021/09/26/bmjspcare-2020-002732.abstract AB Objectives Development of evidence-based good practice recommendations for clinicians considering the use of antibiotics in patients towards the end of life.Design A multiprofessional group of experts in end-of-life care and antimicrobial stewardship was convened. Findings from a scoping review of the literature and a consultation of clinicians were triangulated. Expert discussion was used to generate consensus on how to approach decision-making.Setting Representatives from hospital and a range of community health and care settings.Participants Medical, pharmacy and nursing professionals.Main outcome measures Good practice recommendations based on published evidence and the experience of prescribers in Scotland.Results The findings of 88 uncontrolled, observational studies of variable quality were considered alongside a survey of over 200 prescribers. No national or international guidelines were identified. Antibiotic use towards the end of life was common but practice was highly variable. The potential harms associated with giving antibiotics tended to be less well considered than the potential benefits. Antibiotics often extended the length of time to death but this was sometimes at the cost of higher symptom burden. There was strong consensus around the importance of effective communication with patients and their families and making treatment decisions aligned to a patient’s goals and priorities.Conclusions Good practice recommendations were agreed with focus on three areas: making shared decisions about future care; agreeing clear goals and limits of therapy; reviewing all antibiotic prescribing decisions regularly. These will be disseminated widely to support optimal care for patients towards the end of life. A patient version of the recommendations has also been produced to support implementation.No data are available.