title: Ethical issues relating to the use of antimicrobial therapy in older adults.
abstract: This article aims to review the literature relating to the ethics of antibiotic prescription decisions in older adults and to offer some suggestions as to how one might approach these difficult problems. According to many studies, most patients and their family members wish to receive antibiotics even when they are terminally ill or suffering from advanced dementia. Health care professionals are also frequently reluctant to deny the use of antibiotics in such situations. We suggest that the difficult decisions regarding whether one should withhold treatment can be based on consideration of the ethical principles of autonomy, beneficence, nonmaleficence, and justice. From the public health point of view, one should also take into account the need to avoid the emergence of antimicrobial resistance, keeping in mind the balance between the benefit to the specific patient and the cost to future patients. Infectious diseases consultants should actively participate in these ethical dilemmas.
authors.affiliation: Acute Geriatric Department, Sarah Herzog Hospital, Jerusalem, Israel. elm@inter.net.il
authors.forename: E L
authors.initials: EL
authors.lastname: Marcus
authors.forename: A M
authors.initials: AM
authors.lastname: Clarfield
authors.forename: A E
authors.initials: AE
authors.lastname: Moses
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003141:Communicable Diseases / Q000188:drug therapy*; D004992:Ethics, Medical; D016330:Frail Elderly; D006801:Humans; D013727:Terminal Care; D019452:Terminally Ill
chemical_list: D000900:Anti-Bacterial Agents