Recently, a family that was receiving a consultation on Hospice asked me something that I get asked routinely. “If my loved one gets a urinary tract infection, will they get an antibiotic?” Apparently, when this family spoke with their physician, they were told that when a patient goes on hospice, they are no longer eligible for antibiotics. This statement is not true, this is a case-by-case situation, and that starts with knowing where the patient’s ability to take antibiotics is and if the treatment will improve the symptoms. Let’s start with antibiotics and their purpose.
Antibiotics work on a bacterium that is foreign and overgrown in an area of the body. The bacteria grows and grows, destroying the natural flora in the area, causing redness, irritation, pain, fever, and, if not treated, sepsis. Sepsis: this is where the bacteria spreads and begins growing in other areas causing a powerful infection that can cause death. Most antibiotic byproducts are processed in the kidney or liver. If the kidneys or liver are failing, an antibiotic may have more damaging effects then are worth the attempt. Also, if a patient has re-occurring infections, the potential for the bacterium to build a resistance to treatment is increased with every course of antibiotics. This is where bigger and more aggressive antibiotics are required. These medications are often given intravenously, may require a hospital stay and laboratory draws to monitor toxic anti-infective levels, kidney, and liver functions. If a patient is in the dying process, the point of an antibiotic may be mute.
However, if a patient is having infection symptoms, can take antibiotics, and is not in kidney or liver failure then an antibiotic should be prescribed, and it usually is. I spent a lot of time researching for this blog and I was encouraged to see so many recent studies on antibiotic use in hospice care. In the article, Should we refrain from antibiotic use in hospice patients?, Expert Review of Anti-infective Therapy by Jon P. Furuno, Brie N. Noble & Erik K. Fromme (2016) “Regarding whether we should refrain from antibiotic us in hospice patients, our best answer is ‘no’ or “that depends.” Please feel free to read their article.
In another article, The Use of Antibiotics in Hospice and Palliative Care Settings, published by the Journal of Hospice and Palliative Care, (March, 2022). The authors state, “The goals of antibiotic therapy for recipients in hospice and palliative care are different than the foals of antibiotic therapy in a non-hospice patient population. One of the main goals of hospice and palliative care overall is quality of life preservation during patients’ final stages of life and letting the patients “die with dignity”. Because of this, many have argued that the primary goal of antibiotic therapy in hospice and palliative care setting should be symptom relief.”
While antibiotics are not meant to cure the patient, it can alleviate and relieve some of the side effects of the infection and should be given when appropriate to the individual patient. Individually, the prognosis of the patient, including where they are in the end-of-life process should always be considered first. At Generations Hospice Care, infection control is documented and studied. We monitor infections due to the level of discomfort that can occur for the patient. In the past 9 months, antibiotic therapy has been prescribed to 12% of our patients. This is all patients who have been identified as having an infection in our census. All these patients fell into the criteria of being able to receive antibiotic therapy and finish the course of treatment before entering the last few days of their life.
While I know that misconceptions and misinformation are easily accessed, so are the realities of hospice care. Arming yourself with the knowledge to make an educated decision about placing yourself or a loved one on Hospice is the best and most important action you can take. If you are struggling with that decision, please reach out to the Generations Hospice Team. We are here to help.