Does Hospice Give Antibiotics? – Treatment of Infections


Antibiotics have their value in health care, and are frequently used in hospice.

Centers of Disease Control and Prevention reports that in 2014, 266.1 million courses of antibiotics are dispensed to outpatients in U.S. community pharmacies. This equates to more than 5 prescriptions written each year for every 6 people in the United States.

That is a lot of antibiotics!  It may be a valid concern they are being prescribed too liberally, but they also save lives. Viruses do not typically benefit from treatment with antibiotics.  Infections that are caused by some of the bad types of bacteria are the target for these medications.

There are several types of bacteria, which can lead to illness. Discovered in 1670s, microorganisms live in every part of the biosphere, and can only be seen under a microscope.  While most are beneficial to our ecosystem, there are some predators. Microorganisms likely far outweigh all other living things combined.  Antibiotics began to make their way into healthcare in 1945, with Penicillin being the first, grown from a fungus.

Currently there are many antibiotics on the market.  The science and research continues as antibiotic resistance exists as a growing problem.

Before antibiotics, passing away from an infection like pneumonia, was common and culturally accepted as a natural death.   And yes, antibiotics can be effective toward keeping these harmful microorganisms at bay, and extending life.  Unfortunately, over time these bacteria can start to permanently live in the body. They can become quite strong, and able to resist the power of antibiotics.  A battle is going on in the body to fight infection, and antibiotics are not guaranteed to always be effective.

The Role of Antibiotics in Hospice

Serious illness and disease can make the hospice patient particularly vulnerable to infections.  These patients have a weakened immune system, and may not be getting the necessary nutrients in their diet to fight off infections.   It is strongly recommended that if you or your loved one suspect any type of infection, do not wait.   In most scenarios, the sooner you intervene, the better the outcome.

The hospice doctor will treat infections when a patients starts to demonstrate symptoms.  The treatment usually consists of an antibiotic that is taken by mouth.   On occasion, an antibiotic called Rocephin is administered by a series of shots in the muscle, over the course of several days.   These injections can be unpleasant, and patients report soreness to the muscles for several days following.

If you or your loved ones perceive that  quality of life is exists, the benefits of antibiotics in hospice care far outweigh the risks.

Antibiotics that are prescribed by your hospice doctor, will depend on type of infection that is suspected.  There are other factors considered that are unique to the individual.  The general understanding of treatment with antibiotics in hospice is to prolong life. There are some infections that will not be cured.  Many patients require treatment with antibiotics every few months to keep an infection in check.  It not unusual for a patient with a persistent infection, for the doctor to prescribe a low dose of an antibiotic daily as a preventative measure, also called prophylaxis.

Oral antibiotics are considered to be a conservative treatment, and are typically the first thing a doctor will prescribe in most health care settings.  When infections are caught early, this type of treatment is quite effective.  If an infection is ignored, there is a high risk that the bacteria will take over, and can migrate into the bloodstream.  This condition is called sepsis or septic shock, and is considered a medical emergency.  Aggressive treatment is often required in a hospital setting.  These patients receive very strong antibiotics given directly into the bloodstream through an IV.   These antibiotics have some serious side effects, and patients must be monitored closely for changes in kidney function.

Aggressive treatment for infections with IV antibiotics is not in line with the hospice philosophy of comfort care.  These types of hospitalizations can rigorous, and are a last resort effort to prevent what is really considered a natural death.  In a moderately healthy person, this would be a reasonable intervention.  Sadly when someone is suffering from serious illness or disease, even these types of aggressive measures can be unsuccessful in prolonging their life.

Three Major Categories of Infection

Urinary tract infections, also known as a bladder infections, are very common in hospice care.

This type of infection is very common when someone is not taking in enough fluid, or has urinary incontinence and wearing diapers.  Also conditions that make is difficult to empty the bladder like a swollen prostate or bladder prolapse can place these patients at a higher risk.   In a healthy, young person, bladder infections are easier to detect, because many will experience pain with urination with increased sense of urgency to urinate.  In the elderly and chronically ill population, these infections can be a little more sneaky.  If you or loved one abruptly starts having increased weakness and fatigue, with a decreased desire to eat, this could be a warning of sign of potential infection.  The hospice nurse will assess for other indicators, like changes in the appearance or odor of urine, fever, and pain.  If a bladder infection is suspected, the hospice with doctor will prescribe an appropriate antibiotic.

Skin related infections can be very serious and the potential complications can be devastating if they are not treated.

In hospice it is not uncommon to develop wounds and ulcers.  When this occurs, it important for the hospice nurse to be attentive to keeping the area clean and covered if necessary to prevent bacteria from attacking the weakened area to the skin.  There are several warning signs and symptoms of infection that may be present, when it involves the skin.  If the majority of them are present, then the hospice doctor may want to consider treatment with antibiotics. The following are symptoms to watch for with skin irritations.

  • Redness to the surrounding skin
  • Increasing intensity of pain to area of skin affected
  • The wound is draining fluid or has pus
  • A strong foul odor
  • Fever or chills

Respiratory infections are those involving the lungs or airway, and hospice patients are particularly vulnerable.

If you or your loved has a worsening cough or chest congestion, the hospice nurse will assist with the management of shortness of breath and symptoms.   The there are other measures to treat respiratory infections in addition to antibiotics.  Infections can range from mild upper respiratory infection to a very serious pneumonia deep within the lungs.  These patients can benefit from over the counter cough medications, breathing treatments with a nebulizer, and supplemental oxygen therapy.   Contact your hospice nurse if you or your loved one start experiencing the  following symptoms.

  • Chest congestion 
  • Coughing 
  • Shortness of Breath
  • Fever and Chills
  • Abrupt onset of weakness and fatigue
  • Decreased Appetite

Commonly Recognized Generic Antibiotics

  • AMOXICILLIN – This a medication that is in the family of Penicillin and is widely used for treating infections related to the lungs, skin, and urine.  Brand Name is Augmentin. 
  • AZITHROMYCIN – This is an effective medication for treating mild upper respiratory infections and mild skin infections.  Most commonly known as a Zpak.
  • CEPHALEXIN– This medication is also called Keflex and it works well for the treatment of skin infections, but can be used in treating urinary and respiratory infections as well. 
  • CIPROFLOXACIN – Many remember Cipro and the high demand for it, when we faced the anthrax scare.   This medication is highly effective in treating urinary tract infections. 
  • CLINDAMYCIN – This medication has a brand name of Cleocin and is very strong.  This medication is very effective in treating severe skin and respiratory infections. 
  • DOXYCYCLINE – In the drug class of the familiar Tetracycline used to treat severe acne.   It is occasionally used in hospice, known to be effective for skin irritation and symptoms of a bladder infection.  
  • LEVOFLOXACIN – Very commonly used in hospice, known to be a strong antibiotic for patients with impaired kidney function.  This is standard medication used for treating suspect pneumonia.  It is also highly effective in lower doses for treating urinary and skin infections.     
  • METRONIDAZOLE More commonly referred to as the brand name Flagyl.  This medication is used for infections are more related to yeast and for a common infection of the colon called Clostridium Difficileotherwise referred to as “C-diff”.   
  • NITROFURANTOIN – This medication is very effective in treating Urinary Tract Infections, and it commonly used taken on a daily basis in a lower dose as a preventative.  The brand name is Macrobid, but caution is used with hospice patient that may have some problems with kidney function. 
  • SULFAMETHOXAZOLE/TRIMETHOPRIM  Many recognize this medication at Bacterim DS is commonly used for infections related to urine.  It is also effective in treating respiratory infections.   This particular medications can irritate that stomach, and many will report an allergy to “Sulfa” drugs. 

Other Considerations:

Allergies to Medications

It is not uncommon someone to have a true allergic reaction to antibiotics specifically.  This is an immune response that is triggered in the body, and is considered a medical emergency. Be sure to seek immediate medical attention in the event of anaphylaxis or severe allergic reaction.  A repeated exposure to a medication that someone is allergic to, can have serious consequences.  If you have ever taken a medication that has caused a rash, itching, shortness of breath, or swelling of the tongue be sure to alert your hospice nurse.  A common side effect of antibiotic therapy is stomach upset, and this is not considered to be an allergy.

Probiotics

There are several types bacteria found in our bodies that are helpful and part of our natural defense mechanism.  Antibiotics prescribed by the doctor will often destroy these good bacteria along with the bad.  There may be a potential benefit in supplementing your diet with a good probiotic.  These tablets contain live bacteria and yeast that can help support the immune system.  Some people will eat yogurt with antibiotics based on this same principle.  The problem with this approach is that cultures in yogurt have a very short life span.  To really benefit for eating yogurt, it would be preferable to seek out a farmer’s market to buy the organically produced type.  Probiotics claim to have a positive impact on digestion, because many people suffer from excessive yeast growth in the gut.  When shopping for a probiotic there is quite a range in quality and price.  Consider the pharmaceutic grade probiotic supplements.  They tend to have a more strains and higher counts of live bacteria.  tty good.  Because of the importance of the capsule to pass through the stomach and to be absorbed in the small intestine, the vegetable capsules would be preferred.

A Natural Approach

I do believe that natural medicine and a holistic approach has a place in health care.  Diet influences many aspects of our health, and we as country in a crisis because of our eating habits.  Vitamin C has famous reputation for being an immune booster, and I cannot find a reason to discourage it.  Another little gem is a cranberry supplement because of the known effects of cleaning out the urinary tract.  Drinking cranberry juice has a value, but the sugar content is high and can be hard on the stomach.  I always prefer the chewable kind of supplement, because of the likelihood of improved absorption.

Can we naturally treat infections with holistic measures?  No one can the discount the simplicity and effectiveness of hydrogen peroxide in attacking infection, although it is not recommended to be used in healing non-infections wounds because it may slow the healing process.  I stumbled on this e-book and I felt compelled to share it.   The Antibiotic Epidemic may be helpful for someone who is interested in more holistic approach to their health.

Click Here for More Information on this book.

Your hospice nurse with guide you on antibiotics prescribed under the direction of the doctor.  Antibiotics can be very effective when used under the right circumstances.

I hope you found this information helpful.  Please feel free to leave comments or questions.




4 Comments

  • Jacquie August 5, 2017 at 2:23 pm

    I, personally, am a little scared of antibiotic resistance, and as such, try and maintain a daily ‘dose’ of probiotics for me and my family.

    I know it’s different in a hospice care setting, where a smooth transition to end of life is the goal, but I cannot help but wonder why patients, in general, cannot be offered probiotics as a standard, instead of and also in addition to prophylactic antibiotics, and wean off antibiotics eventually?

    Antibiotics save lives, and as such, they should be used less liberally, in my humble opinion. I’m shocked at how prescriptions are dished out easily, given the resistance levels.

    Fab blog by the way!

    Reply
    • Heather Williams RN CHPN August 7, 2017 at 5:34 pm

      Thank you for taking the time to read antibiotics. The idea of superbugs and non-effective antibiotics is a little scary, but we as a community need to take charge and increase awareness. Many doctors are starting to prescribe a daily probiotic, these supplements have gotten a lot of attention over the couple of decades. They do vary in quality and as a consumer, I would probably stick to the pharmaceutical grade. Antibiotics do have their place and value, and I think we need to find a balance between traditional and holistic medicine.
      Take Care,
      Heather

      Reply
  • Wendi August 5, 2017 at 5:05 pm

    I believe that if time is of the essence, and that there are only antibiotics available to reverse the effects of an infection, then the antibiotics should be taken and without delay. However, I am an advocate of using the most natural and holistic approaches to health care when possible. I didn’t know the effects of hydrogen peroxide on infections, so now I will do more research to educate myself. This kind of information is beneficial to not only individuals or loved ones of those in hospice care, but just about anyone who has the potential to suffer from infections–and that’s everyone!

    Reply
    • Heather Williams RN CHPN August 7, 2017 at 5:35 pm

      I am happy that you found this topic of antibiotics helpful. I appreciate your feedback.
      Take Care, Heather

      Reply

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