To understand the antimicrobial prescription patterns in patients with terminal or life-limiting illness in intensive care unit- An observational study

The general goal of antimicrobial therapy is to increase patient’s survival and cure infectious diseases. Because antimicrobial agents are unable to alter the progression of underlying diseases or rather sometimes can prolong suffering in patients at the end-of-life, the goal of prolonging life should be weighed against the risk of prolonging suffering.  Thus, the goal of antimicrobial therapy shifts from improving survival to symptom control with a shift in the goal of care from cure to palliation.  The goal of antimicrobial therapy for terminal patients at an early stage can include symptom control and improvement in survival while maintaining the quality of life.  Antimicrobials however do not change the natural course of disease.  Also, no difference in frequencies of documented symptoms with the use of antimicrobials was seen in a retrospective study at end-of-life.

We do not have information from the Indian subcontinent.  Results of this audit should serve as a living document for re-visiting antimicrobial prescription practices by physician prescribers and set up antimicrobial stewardship guidelines for terminally ill patients such that these can be viewed as aggressive care in end-of-life situations.