From: Reuters
Published February 25, 2008 05:53 PM

Study questions antibiotics for dementia patients

By Will Dunham

WASHINGTON (Reuters) - Old people with advanced dementia who are near death in nursing homes often are given antibiotics to fight infections, possibly prolonging the dying process, researchers said on Monday.

The study, published in the journal Archives of Internal Medicine, found that 42 percent of a group of people incapacitated with advanced Alzheimer's disease or other forms of dementia were given antibiotics at a nursing home in the two weeks before they died.

In fact, these bed-ridden, incapacitated patients, average age 85, were seven times more likely to have been prescribed antibiotics in the last two weeks of life compared with six to eight weeks before death, the researchers found.

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"Yes, you should treat infections with antibiotics," said Dr. Erika D'Agata of Beth Israel Deaconess Medical Center in Boston and Harvard Medical School, who worked on the study.

"But in this case, in somebody who is two weeks prior to death, are the antibiotics doing any benefit? Are they improving the quality of life of this bed-ridden person?" D'Agata said in a telephone interview.

D'Agata worried that this use of antibiotics also may help spur the development of drug-resistant bacteria.

The researchers followed antibiotic treatments given to 214 patients with advanced dementia in 21 Boston-area nursing homes. Many were treated for pneumonia, D'Agata said.

"Patients with advanced dementia ... have no verbal or communicating skills whatsoever, no bowel or bladder function," D'Agata said.

Antibiotics often were given intravenously instead of orally, possibly causing discomfort, she said.

D'Agata and fellow researcher Dr. Susan Mitchell noted that recurrent infections and fever are common in people in nursing homes with advanced dementia. They want to see guidelines developed to reduce the use of antibiotics in these patients.

D'Agata said families may direct doctors not to resuscitate or hospitalize these patients, but there is no similar "do-not-give antibiotics" order.

Dr. Robert McCann of the University of Rochester Medical Center in Rochester, New York, said patients in nursing homes with end-stage dementia most often die of infections as they experience a decline in function and immune resistance.

"There is little evidence that this treatment enhances the quality of their life and, at best, prolongs the dying process," said McCann, who was not involved in the study.

In an editorial in the journal accompanying the study, Dr. Mitchell Schwaber and Dr. Yehuda Carmeli of the Tel Aviv Medical Center in Israel said the solution is not to categorically deny these patients antibiotics.

"We must, however, begin to consider every decision to use antibiotics in this population as we would decisions regarding other treatment modalities, including resuscitation and major surgery. That is, we must ask whether the interests of the patient are being served by using antibiotics," they wrote.

(Editing by Alan Elsner)

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