The why of antimicrobial prescribing during transition to comfort care

Reviewed by Jose Lucar, MD, The George Washington University

Antimicrobial use is common at the end of life, thus evaluating the rationale for antimicrobial prescribing when transitioning to comfort measures only (CMO) is needed to guide potential antimicrobial stewardship interventions. In this single-center study, Larnard and colleagues distributed a cross-sectional, electronic survey to providers in medical subspecialities and conducted a retrospective chart review of patients who received antimicrobials in the 48 hours prior to transition to CMO. They found that patient/family preference (78%) and perceived symptom palliation (62%) were the most common factors involved in deciding whether to continue antimicrobials after transition to CMO, emphasizing the need for evidence regarding the palliative benefits of antibiotics. Among the 26% of patients who remained alive 48 hours after the CMO order, 14% were still receiving antimicrobials.  

Larnard J, Blackshear L, Lee MSL, Buss MK, Stead W. Perceptions and Reality of Antimicrobial Prescribing During the Transition to Comfort Measures Only at an Academic Medical Center. Open Forum Infect Dis. 2022 Dec 26;10(1):ofac692.

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