ANTIBIOTICS

Antibiotics have an important place in controlling symptoms in advanced disease. If an infection is causing symptoms it should be treated promptly (after a swab or specimen has been taken for bacteriology) with an appropriate antibiotic (always ask about drug allergies).

A broad-spectrum antibiotic is indicated for cellulitis, pulmonary or urinary tract infections, sometimes as a trial in a patient with sweating that may be secondary to bacteremia, or while awaiting laboratory sensitivities.

Chloramphenicol 500mg 4 times a day is very useful as a broad-spectrum antibiotic which is active against anaerobes. It is refreshingly free of side-effects. (Bone marrow damage is rare, occurring in about 1 in 30,000 patients, which is an acceptable risk for an individual patient with advanced disease.)

It is occasionally correct practice to withhold antibiotics for a potentially fatal pneumonia (and treat any symptoms of dyspnea, cough or pleuritic pains with morphine and scopolamine). Sometimes during a discussion about quality of life the patient requests no further active treatment of pulmonary infections. At other times the decision has to be made by the doctor (preferably one who knows the patient well) that further active treatment would be prolonging dying and “officiously striving to keep alive” rather than promoting quality of remaining life.


 

 


The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.


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