Rationale: Infections and fever episodes are among the most common acute complications in patients nearing the end of life. A significant proportion of dying patients receive intravenous antibiotics in their final week. However, antibiotic treatment carries risks, including drug reactions, Clostridium difficile colitis, and interactions with other medications. Additionally, unnecessary antibiotic use contributes to antimicrobial resistance and should be avoided.
If antibiotics are considered, minimal diagnostic tests should be performed to confirm a bacterial infection. Fever alone should not be an indication for treatment. Patients should be informed about the possibility of infections in their final phase of life, and discussions on the benefits and drawbacks of antibiotic therapy should be included in end-of-life care planning. Clinicians must explore with patients whether life-prolonging treatment is desired. Evidence for symptom relief from antibiotic use is weak, and symptom management should primarily rely on palliative treatments.
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