Good practice recommendations for use of antibiotics towards the end of life
This guidance provides recommendations for antimicrobials use in adults approaching the end of life. It is intended for use by healthcare professionals who provide their care.
Overview
This guidance refers to ‘end of life’ as the last few days or weeks of life, but diagnosis or prediction of the actual end of life may not always be easy. Antibiotics use towards the end of life may not change the clinical outcome but may mean that the patient’s care is overly medicalised. This may not align to what matters most to the patient.
The decision to start, or not start, antibiotics in this context requires careful consideration. As in all clinical situations, there is the potential for harm, both for the individual patient (through side-effects, including Clostridiodes difficile) and for the wider community (through promotion of antimicrobial resistance).
Recommendations
1. Involve patients in shared decision making about future care
2. Agree clear goals and limits of therapy
3. Consider alternatives to antibiotics in adults approaching end of life
4. Review all antibiotic prescribing decisions regularly
This was produced by a multi-professional short life working group created by the Scottish Antimicrobial Prescribing Group which included representation from community and care homes, hospitals and hospices who reviewed the use of antibiotics towards the end of life in all settings. Membership of the group included general practitioners, physicians in acute medicine, geriatric medicine, palliative medicine, infectious disease, public health, old age psychiatrists, specialist nurses and clinical pharmacists.
The aim of the group was to optimise antibiotic prescribing practices towards the end of life and to align this with the founding principles of Realistic Medicine – Shared decision making, reducing harm, waste and tackling unwarranted variation.
The recommendations in this document are informed by a scoping review of antibiotic prescribing at the end of life [1], and an unpublished electronic survey of prescriber attitudes and behaviours across all health and care settings in Scotland [2]. Following review and discussion of this evidence, the group agreed key recommendations to support clinicians making decisions about antibiotics towards the end of life.
Scottish Antimicrobial Prescribing Group (SAPG) | October 2023 for review October 2026
Content updated: January 2024