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Redefining the Ethical Dilemma

Mitchell J. Schwaber, MD, MSc; Yehuda Carmeli, MD, MPH

Arch Intern Med. 2008;168(4):349-350.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In this issue of the Archives, D’Agata and Mitchell¹ report extensive use of antibiotics in elderly nursing home residents with advanced dementia. In a cohort of 214 patients followed prospectively for 18 months, two-thirds were treated with antibiotics. Antibiotic use rose as death approached, with significant increases in the numbers of patients treated, antibiotics used, and days of treatment. These are important observations because nursing home residents, especially those with dementia, are a growing population, constitute an increasing proportion of patients hospitalized in acute care facilities, and are often found to harbor multidrug-resistant organisms.²

The findings in this study require the medical community to ask whether the extensive use of antibiotics in this particular patient population is appropriate, taking 2 factors into consideration: the benefit to the patient treated and the risk imposed on other patients. At what point are . . . [Full Text of this Article]

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