Antibiotic Use in Dementia Patients Questioned

By Serena Gordon
HealthDay Reporter
Monday, February 25, 2008; 5:00 PM

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MONDAY, Feb. 25 (HealthDay News) -- Almost half of nursing home patients with advanced dementia are given antibiotics in the last two weeks of life, a new study found.

What's not clear is whether or not that therapy has any benefits, such as prolonging life or improving the quality of life. And, of concern are the risks associated with antibiotic use, such as pain from intravenous antibiotics and unpleasant side effects, as well as the fact that frequent use of antibiotics in people with advanced dementia may help fuel the growing problem of antibiotic resistance.

"Antibiotic exposure is extensive in nursing home residents with advanced dementia, and it increases as patients near death," said study lead author Dr. Erika D'Agata, an assistant professor of medicine at Harvard Medical School. "We really need to determine if antibiotics should be given to patients at the end of life. Do they benefit from treatment?"

The study findings are published in the Feb. 25 issue of Archives of Internal Medicine.

About 70 percent of the 5 million Americans with dementia will end up in a nursing home at the end of their lives. Repeated infections and fevers are common at the end of life, according to background information in the study.

"In general, in the population of severely demented elderly patients, as the health of the patient deteriorates, infection becomes increasingly frequent. According to common medical practice, these episodes of infection are usually treated with antibiotics, but death often results nevertheless," the authors of an accompanying editorial in the journal, Dr. Mitchell Schwaber and Dr. Yehuda Carmeli, of the Tel Aviv Medical Center's division of epidemiology, said in an e-mail interview.

To get a more precise idea of how antibiotics are used in nursing home residents with advanced dementia, D'Agata and her colleague, Dr. Susan Mitchell, reviewed data from a group of 214 people and followed them for 18 months or until death.

The researchers found that 66 percent of the patients received at least one course of antibiotics during the study period, and that the average number of days an advanced dementia patient spent on antibiotics was 53 days per every 1,000 days. Respiratory-tract infections were the most common reason antibiotics were prescribed, according to the study.