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Antibiotic Use in Dementia Patients Questioned
Date:2/25/2008

ementia, D'Agata and her colleague, Dr. Susan Mitchell, reviewed data from a group of 214 people and followed them for 18 months or until death.

The researchers found that 66 percent of the patients received at least one course of antibiotics during the study period, and that the average number of days an advanced dementia patient spent on antibiotics was 53 days per every 1,000 days. Respiratory-tract infections were the most common reason antibiotics were prescribed, according to the study.

During the study period, 99 people died. Of those, 42 percent were on antibiotic therapy during the last two weeks of their lives. Many were given antibiotics through an intravenous line or by intramuscular injection.

The next step, according to D'Agata, is to figure out whether these patients benefit from antibiotic therapy, and what are the consequences from the overuse of antibiotics to the patient and to society.

Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City, agreed that more research is needed. "Physicians need a bit more data on outcome than we have from this article. We can't say that we know what the consequences of withholding antibiotics in this group are. If the data says that most of the time treatment with antibiotics doesn't prolong life or improve quality of life, then physicians can go to the families with a recommendation not to treat someone in the advanced stages of dementia," he said.

Schwaber and Carmeli said: "Not every infection [in someone with advanced dementia] must be treated with antibiotics. If no enhancement in the quality of life can be expected by the use of antibiotics, withholding their use may be the appropriate step to take in the case of infection."

However, D'Agata, Kennedy, Schwaber and Carmeli all agreed that the decision to use antibiotics or not needs to be made on a case-by-case basis with the family. And, Kennedy
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