Antibiotic use in terminally ill patients: a cross-sectional study from a University Hospital in Thailand

Abstract

Antibiotic prescribing remains common in terminally ill patients despite limited evidence of benefit. This study investigates the prevalence, clinical outcomes, and cost implications of antibiotic use in end-of-life patients receiving inpatient palliative care. A retrospective cross-sectional study was conducted, reviewing the medical records of 155 end-of-life patients who received palliative care consultations and died between January 1, 2021, and December 31, 2021. Of the 155 patients, 69.68% were diagnosed with cancer, and 94.84% had documented advance care planning. Antibiotics were prescribed in 83.23% of cases, with 71.61% continuing use during the last seven days of life. Respiratory (41.94%) and urinary tract infections (20.65%) were the most frequently identified infection sites, and Klebsiella pneumoniae (16.77%) was the most commonly identified pathogen. Fever was the most common symptom (69.03%) and showed the highest response rate to antibiotics (69.23%), whereas dyspnoea demonstrated limited improvement (13.92%). Gastrointestinal disturbances were the most reported adverse drug reactions (4.52%). The median total cost of antibiotic prescriptions and related care was 16,132.63 THB (IQR: 7,427.15–74,740.39 THB), equivalent to 1,203.93 international dollars (IQR: 554.26–5,577.64). These findings highlight the frequent use of antibiotics in terminally ill patients, often extending to the final days of life, with considerable economic impact. Given the limited symptomatic benefit and high costs, these results emphasise the need to re-evaluate antibiotic prescribing practices in end-of-life care to align with patient-centred goals and cost-effective strategies.