Antimicrobial use at end of life: a missing link in public health discourse

Antimicrobial resistance (AMR) is a global health crisis disproportionately burdening low-income and middle-income countries, with an estimated 5 million deaths per year and an annual cost of $412 billion to treat resistant bacterial infections. Public health discourse on AMR has largely passed over its overuse at the end of life. However, the field must consider how antimicrobials are used in advanced serious illness and at the end of life. Clinical practice guidelines at end of life are scarce, leading to blind continuation until patients’ deaths. The Lancet Commission on Global Access to Palliative Care and Pain Relief identified the global burden of serious health-related suffering that could be relieved through equitable access to palliative care. Multisector stakeholders must address the impact of antimicrobial use at end of life on AMR at the public health level.