title: Can anti-infective drugs improve the infection-related symptoms of patients with cancer during the terminal stages of their lives?
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Hospital Pharmacy Education, Graduate School of Pharmaceutical Science, Osaka University, Osaka, Japan. nakagawa@pharm.kobegakuin.ac.jp
authors.forename: Sari
authors.initials: S
authors.lastname: Nakagawa
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Toya
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Satoru
authors.initials: S
authors.lastname: Tsuneto
authors.forename: Sho
authors.initials: S
authors.lastname: Goya
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tanimukai
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Ohno
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Eto
authors.forename: Mamiko
authors.initials: M
authors.lastname: Tsugane
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Takagi
authors.forename: Etsuko
authors.initials: E
authors.lastname: Uejima
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology*; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000517:prevention & control; D006304:Health Status; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D011788:Quality of Life / Q000523:psychology; D012189:Retrospective Studies; D013727:Terminal Care
chemical_list: D000890:Anti-Infective Agents; D002097:C-Reactive Protein