ANTIBIOTIC use at the end of life often offers limited symptom relief while increasing treatment burden.
Antibiotic Use at the End of Life and Symptom Relief
Antibiotic use at the end of life remains common across hospice, hospital, community, and long term care settings, even when infection is not clearly confirmed. The review highlights a persistent clinical tension: whether antimicrobials meaningfully improve comfort in the final weeks of life, or instead add interventions that do not align with patient goals.
The evidence suggests that symptom relief is inconsistent and depends heavily on infection type. Reported benefit appears strongest in sepsis, where about half of patients may experience improvement. By contrast, urinary tract infections appear to offer much lower symptom response, at roughly 17%, while respiratory infections and infections with an unclear source show even less reliable benefit. These findings reinforce that antibiotic use at the end of life cannot be viewed as a uniform comfort measure.
Treatment Burden Can Outweigh Potential Gains
For many patients nearing death, the burden of treatment may be substantial. The review points to adverse effects, discomfort from intravenous access, hospital transfer, and the broader consequences of antimicrobial resistance as important harms that should factor into decision making. In this setting, prescribing is not simply about whether infection is present, but whether treatment is likely to improve symptoms in a way that matters to the patient.
That question becomes especially important when care priorities have shifted toward comfort. Antibiotics may still have a role, but the review makes clear that their use should not be automatic. Instead, expected benefit should be weighed against the physical and logistical burdens created by treatment itself.
Stewardship and Shared Decision Making Matter
The authors argue that antibiotic prescribing near the end of life should be guided by patient goals, likely symptom benefit, and a clear effort to minimize unnecessary burden. Stewardship also remains central, particularly given the risks of resistance and the potential for antimicrobial use without confirmed infection.
Shared decision making is therefore essential. Clinicians must navigate uncertainty while helping patients and families understand that antibiotic use at the end of life may sometimes support comfort, but in other cases may prolong interventions without meaningful relief. The central message is a practical one: align treatment with goals of care, use antibiotics selectively, and prioritize patient centered outcomes over routine prescribing.
Reference
Alzahrani M et al. Antibiotic Use at the End of Life: Balancing Symptom Relief, Treatment Burden, and Stewardship. American Journal of Hospice and Palliative Medicine®. 2026;doi:10.1177/10499091261447384.
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