🩺 Antibiotics at the End of Life: Comfort First, Not Cure: A PLAB 2 mock Scenario
- Ann Augustin
- Jun 18
- 3 min read
Updated: Jun 24
Antibiotics have long been part of routine clinical care, but their role in palliative and end-of-life care is less straightforward. In the UK, as in many parts of the world, the emphasis in palliative care shifts from curative intent to comfort, dignity, and quality of life. So where do antibiotics fit in when a patient is nearing the end of life?
Let’s explore the current UK recommendations and clinical best practices.
💬 Why Is This a Critical Question?
Infections are common in patients with advanced illnesses—urinary tract infections, respiratory infections, and sepsis often appear in the last days or weeks of life. While antibiotics may seem like a logical next step, their use in palliative care is not always beneficial, especially when the goal is no longer to prolong life.
📜 UK Guidance and Professional Consensus
1. National Institute for Health and Care Excellence (NICE)
While NICE does not provide a standalone guideline specifically for antibiotic use in palliative care, its broader recommendations under NG31: Care of Dying Adults in the Last Days of Life emphasize:
"Antibiotics should only be considered if they are likely to provide symptomatic benefit."
This means antibiotics should not be given reflexively, but rather when they align with patient goals and are expected to relieve distressing symptoms like fever, pain, or confusion caused by infection.
🔗 NICE NG31 - End of Life Care
2. General Medical Council (GMC) — Treatment and Care Towards the End of Life
The GMC encourages clinicians to:
Evaluate whether treatments (including antibiotics) provide benefit in terms of comfort
Involve patients (or their families/surrogates) in shared decision-making
Avoid burdensome or non-beneficial interventions during the actively dying phase
🔗 GMC Ethical Guidance
🔍 What Does the Evidence Say?
A 2023 review published in The American Journal of Hospice & Palliative Medicine (PMC10180008) found that:
Up to 80% of hospice patients in some settings receive antibiotics in the last weeks of life.
However, symptom relief is not consistently achieved, and antibiotics may prolong the dying process or introduce new problems like nausea, diarrhea, and the burden of IV lines or hospital admissions.
The authors recommend withholding antibiotics during the actively dying phase unless a clear symptom-relieving benefit is expected.
❌ When Antibiotics May Be Withheld
Antibiotics may not be appropriate when:
The patient is actively dying (final hours to days)
There is no clear evidence the antibiotic will relieve distress
The patient or family has opted for comfort-only care
Use of antibiotics imposes disproportionate burden (e.g., hospitalization, invasive lines)
✅ When Antibiotics May Be Used
Antibiotics can be considered if:
There is a symptom control indication (e.g., pain, foul odour, fever, delirium)
The infection causes significant distress and relief is expected
The patient expresses a preference for continued treatment
Benefits outweigh the risks
🧭 Practical Decision-Making Framework
🩹 Summary
In the UK, antibiotics at the end of life are not automatically given, and should only be used if they are:
Symptom-focused
In line with the patient’s care goals
Not burdensome in terms of administration or side effects
💡 Palliative care is not about doing nothing—it’s about doing what matters most. That may include antibiotics… or it may mean letting go of treatments that no longer help.
🗨️ Final Thought
As clinicians, it is our role to shift from “What can we do?” to “What should we do?”—and antibiotic decisions in end-of-life care are a clear place to apply this wisdom.
📚 References:
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