Descrição do benefício do uso de antibióticos para o controle de sintomas em pacientes em cuidados paliativos e de fim de vida: uma revisão sistemática

Abstract

The prescription of antibiotics in patients undergoing palliative and end-of-life care is prevalent, reaching more than 80%, with significant persistence after the introduction of end-of-life care. Many of these patients face futile treatments, which may not offer clear clinical benefits but carry unnecessary side effects and costs. Despite this, the administration of appropriate antibiotics can provide symptom control, quality of life and even impact on mortality. The ethical dilemma surrounding the prescription of antibiotics requires consideration of the opinions of doctors, patients and family members. This study aimed, through a systematic review, to evaluate whether the use of antibiotics leads to an improvement in symptoms or quality of life in patients receiving palliative and end-of-life care. Additionally, we seek to describe the proportion of patients who used antibiotics and the possible association with mortality. The methodology adopted followed PRISMA guidelines, including prospective observational studies and clinical trials, from peer-reviewed publications. After an exhaustive search, 5 articles were selected. Results indicated that the use of antibiotics may be related to an improvement in symptoms in up to 65% of cases, with few reports of significant adverse effects. Considerations regarding current guidelines and the need for ethical dialogue in decision- making were highlighted. Limitations of the review include the heterogeneity of studies and the lack of conclusive data on mortality. It is suggested that future studies be carried out with a more structured protocol and standardized criteria, in order to facilitate comparison and offer clearer guidelines for the use of antibiotics in palliative care.