Bacterial infections in palliative care: antibiotics and therapeutic limitations

The benefits of antibiotics treatments are not obvious at the end of life except for the symptomatic urinary infections. The numerous antibiotics prescribed raise economic and ecological problems in terms of bacterial resistances development and also in terms of quality of life. The control of symptoms has to be the main indication to prescribe antibiotics at the end of life. It is the general state, the prognostic of the patient, his wishes and those of his family, and his symptoms, controlled or not, that direct the decision to prescribe an antibiotic. Physicians must consider the objective of antibiotic treatment, the risk of side effects and the constraints related to this treatment before prescribing it for terminally ill people. They have to respect the bioethical principles, primarily the principles of beneficence, non-maleficience, and the respect to autonomy of the patient. In the event of decision of an antibiotic treatment at a patient at the end of the lifetime, the choice of this one must answer obviously the same requirements as in the other medical situations, within the framework of comprehensive and rigorous process.