Department of Hospital Pharmacy Education, Graduate School of Pharmaceutical Science, Osaka University, Osaka, Japan.
J Palliat Med. 2010 May;13(5):535-40. doi: 10.1089/jpm.2009.0336.
Appropriate use of anti-infective drugs is essential in clinical practice. No evidence-based guidelines or protocols have been published on the appropriate use of anti-infective drugs in patients receiving palliative care as yet.
The medical records, which included the demographic data of patients, anti-infective drug use, bacteriologic findings, symptoms, and hematologic findings were reviewed retrospectively to determine the potential factors that contribute to symptom improvement of patients in terminal phase.
Seventy-one patients (64%) who received anti-infective drugs and had a total of 326 episodes of infection were assessed. Symptom improvement was seen in 33.1%. A total of 22.6% of episodes were started on anti-infective drugs during the last week of life and the symptom improvement in these episodes was 9.2%. Symptom improvement was hardly observed when the anti-infective drug was administered during the last week of life. The association between the decrease in the C-reactive protein (CRP) levels, the decrease of the leukocyte count, reduction of fever, and symptom improvement was determined. The decrease of CRP levels was 42.4%; leukocyte, 56.7%; and reduction of fever was 28.4%. The symptom improvement of individual treatment history was also investigated. The symptom improvement of the group who took positive treatment such as chemotherapy, radiotherapy, surgery, and catheter placement was significantly lower than that of no-treatment group.
Active cancer treatment probably induces the symptoms related to infection and the use of anti-infective drugs. Unnecessary and excessive treatment should be avoided, and the symptoms should be managed with consideration of the patient's state of mind in order to improve the quality of life of terminally ill patients.
在临床实践中，合理使用抗感染药物至关重要。目前尚未发表关于姑息治疗患者抗感染药物合理使用的循证指南或方案。
回顾性分析患者的病历资料，包括人口统计学数据、抗感染药物使用情况、细菌学检查结果、症状和血液学检查结果，以确定导致终末期患者症状改善的潜在因素。
共评估了 71 例（64%）接受抗感染药物治疗且共发生 326 次感染的患者。症状改善率为 33.1%。共有 22.6%的感染发生在生命的最后一周开始使用抗感染药物，这些患者的症状改善率为 9.2%。在生命的最后一周使用抗感染药物时，症状改善几乎观察不到。确定了 C 反应蛋白（CRP）水平下降、白细胞计数下降、发热消退与症状改善之间的关联。CRP 水平下降 42.4%；白细胞下降 56.7%；发热消退 28.4%。还调查了个体治疗史的症状改善情况。接受化疗、放疗、手术和导管放置等积极治疗的组的症状改善明显低于未治疗组。
积极的癌症治疗可能会引发与感染相关的症状，并需要使用抗感染药物。应避免不必要和过度的治疗，并应考虑患者的心态来管理症状，以提高终末期患者的生活质量。
