Use of Antibiotics in Infected Elderly Patients at the End of Life for the Management Ofsymptoms, Quality of Life and Comfort: A GRADE Framework Approach

Abstract

Background: There is scarce evidence about the use of antibiotics in patients at the end of life, therefore, the palliative care and other healthcare professionals involved in the care of these patients do not have support if this type of intervention attenuates suffering or if improves quality of life and comfort. This study objective was the generation of a recommendation for the use of antibiotics in patients at the end of life, based on the bestevidence available.

Methods: The GRADE framework Evidence to Decision (EtD) was used as methodology and systematic review was performed to identify the best evidence available. The appropriate instruments were applied to assess the quality of the evidence and build the evidence framework. The search was oriented on the identification of evidence that involved the effect of antibiotic use in patients at the end of life that were infected or with suspicion of infection on the symptoms control, comfort and quality of life.

Findings: The number of studies available for eligibility after the search were 2.984, 51 were selected for full text assessment and only one study was identified that sufficed the eligibility criteria, nevertheless, it only assessed symptoms control in 133 patients. A single session of consensus with experts on the different therapeutic areas related to the defined clinical scenario was performed and a recommendation was made.

Interpretation: The expert consensus determined that the use of antibiotics in patients atthe end of life with infection or suspicion of infection is not recommended.

Keywords: Quality of Life, Terminal Care, Antiobiotics