Onkológia 6/2017

Antibiotic treatment at the end of life – a case report

Purpose: Purpose of this case report is to present a situation well known by oncologists - patient with uncontrolled cancer suffering from infection. With the help of literature and clinical trials we try to find out which patients at the end of their lives benefit from antibiotic treatment. Case: We present a patient with local recurrence of rectal carcinoma. Rectovesical fistula formed owing to his treatment, causing subsequent recurrent urinary infections. Their successful treatment caused the patient to spend a signigicant portion of his life at the hospital. When his performance status declined due to progressive malignancy and bacteria causing infections became resistant to antibiotics and we informed him about his condition, we mutually agreed not to treat the subsequent infection. The next infection was at first successfully treated with antipyretics.. Shortly, his symptoms recurred and the patient died in a few days. Conclusion: Whether to treat or not to treat infections at the end of life is a complex and individual process and patient´s preference should play an important role in decision making. Results of clinical trials suggest that the main role of antibiotics at the end of life is improvement of quality of life. Their impact on the length of life is unclear.

Keywords: antibiotics, end of life, fever, infection, hospice, palliative care, case report