Thursday, September 1, 2005
The current JPSM has an article prospectively following hospice patients who were given antibiotics to see if antibiotics alleviated symptoms associated with the infections. About 1600 people were followed; 600 were treated with antibiotics for suspected or proven infections & symptoms were prospectively followed. Most infections were UTIs or respiratory. Except for UTI's, 50% or fewer patients had symptomatic improvement with antimicrobials (this included broad spectrum antibiotics such as quinolones for respiratory infections; nystatin and fuconazole for oral infections; as well as skin infections). 66-88% (varied by antibiotic) of the people with UTI's had improvement. The median mortality was at 30 days. Clearly there are lots of problems with this study (no real control let alone randomization; no clear definitions of infection [eg. 85% of the people given gatifloxacin for respiratory infections had no improvement which makes me think they either didn't have infections or were very close to death anyway]; how symptoms were assessed & how it was decided if symptoms improved or not are not described. Nevertheless it describes a very 'real world' process--patient has symptoms; doc wonders if it's an infection; patient gets antibiotics hoping it will make things better--and I think it's useful information that most people with most infections didn't improve with antibiotics. Their experience indicates however that people with suspected UTI's get relief with levofloxacin (88%) and TMP-SMX (78%)--the next logical step would seem to be randomizing hospice patients with suspected UTI's to symptom relief only (analgesics, antispasmodics, etc) or symptom relief plus antibiotics to see if there's any difference.