Antibiotics at the end of life: between symptomatic relief and therapeutic disproportion. Narrative review
El dilema antibiótico en el final de la vida
Authors
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Luzdari Patricia Torres Palacios
Universidad Católica Santiago de Guayaquil Guayaquil, Ecuador. Unidad de Cuidados Paliativos. Instituto Oncológico Nacional Dr. Juan Tanca Marengo. Sociedad de Lucha contra el Cáncer, SOLCA Guayaquil. Guayaquil, Ecuador.
https://orcid.org/0000-0002-9914-261X
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María José Peralta Godoy
Universidad Católica Santiago de Guayaquil Guayaquil, Ecuador. Unidad de Cuidados Paliativos. Instituto Oncológico Nacional Dr. Juan Tanca Marengo. Sociedad de Lucha contra el Cáncer, SOLCA Guayaquil. Guayaquil, Ecuador.
https://orcid.org/0009-0007-3696-2657
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Mariana Concepción Vallejo Martínez
Universidad Católica Santiago de Guayaquil Guayaquil, Ecuador. Unidad de Cuidados Paliativos. Instituto Oncológico Nacional Dr. Juan Tanca Marengo. Sociedad de Lucha contra el Cáncer, SOLCA Guayaquil. Guayaquil, Ecuador.
https://orcid.org/0000-0001-5727-262X
DOI:
https://doi.org/10.33936/qkrcs.v10i1.8338Keywords:
Anti-bacterial agents; palliative care; terminal care; medical futility.Abstract
The use of antibiotics at the end of life represents a clinical and ethical challenge, due to the tension between symptomatic relief and the risk of therapeutic disproportion. In this context, the present study aimed to critically analyze the available evidence on the use of antibiotics at the end of life. To this end, a narrative literature review was conducted from January 2018 to December 2025, with an update in January 2026. Databases including LILACS, Redalyc, PsycINFO, PubMed/MEDLINE, Scopus, and SciELO were searched using descriptors such as palliative care, end-of-life care, antibacterial agents, and medical futility, combined with Boolean operators. Full-text articles in English, Portuguese, and Spanish were included, while studies not related to the topic and duplicates were excluded. A total of 42 studies were identified, of which 32 met the inclusion criteria. At the end of life, antibiotic use is frequent and predominantly empirical, even in the absence of microbiological confirmation. Clinical benefits are variable, with no consistent evidence of improvement in symptom control or survival. Additionally, associated risks were identified, including adverse effects, increased medicalization, and antimicrobial resistance. In this context, antibiotic use should be guided by an ethical and proportional evaluation, prioritizing patient comfort, dignity, and individual values at the end of life.
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Copyright (c) 2026 Luzdari Patricia Torres Palacios, María José Peralta Godoy , Mariana Concepción Vallejo Martínez
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
