Uso de antibióticos no cuidado de fim de vida: uma revisão narrativa

Abstract

End-of-life care presents a significant challenge regarding the use of antimicrobials, as terminal patients receive antibiotic therapy with high frequency despite clinical benefits that are often limited and inconsistent. The analysis is based on a narrative review of scientific literature, selecting observational studies, guidelines and epidemiological data that demonstrate high prescription rates, especially in hospital and palliative care settings, where use may exceed 50% of cases and reach up to 90% in terminal admissions. Patients in this stage face increased infection risk due to immunosuppression, malnutrition, immobility and the use of invasive devices, factors that favor the initiation or continuation of antibiotic therapy even in the presence of a poor prognosis. Evidence indicates that urinary tract infections tend to respond better to treatment, whereas pneumonia in advanced dementia shows inconclusive results and rarely leads to meaningful improvement, suggesting that therapeutic benefit depends on infection type and patient clinical condition. It is also noted that therapeutic decisions are influenced by family expectations and by the perception that discontinuing antibiotics represents abandonment, which may lead to futile treatments, increased adverse effects, prolonged suffering and contribution to antimicrobial resistance on a global scale. In this context, significant gaps persist in the literature, such as the absence of standardized clinical indicators, scarcity of studies measuring symptomatic impact and limited understanding of cultural factors that support low-benefit prescriptions. Given this scenario, there is a reinforced need for patient-centered decisions aligned with goals of comfort, proportionality and dignity in the dying process, with integration of palliative care principles and antimicrobial stewardship programs, in addition to encouraging more robust scientific production to support future recommendations.