[Refractory sufferings at the end of life: Which considerations, which propositions?]. / Souffrances réfractaires en fin de vie : quelles réflexions, quelles propositions ?

Refractory suffering of terminally ill people may be physical (pain, dyspnea, vomiting...) or existential (spiritual sufferings, anxiousness...). End-of-life decisions are often around ethics. Decision making near the end of life consists in witholding and withdrawing life-support treatment and prescribing both of treatments with risk of double effect and sedation for distress. In France, such decisions are defined by the deontology code and by the law of April 22nd, 2005 concerning the end of life and patients' rights. Recommendations from medical societies specify the means of implementation: obtaining other medical opinions, the patient's informed consent and full transparency of the decision (noted in the patient's medical chart).

Pharmacodynamics and pharmacokinetics of antibacterial drugs in the management of febrile neutropenia.

We review experimental and clinical data on the pharmacokinetics and pharmacodynamics of antibacterial drugs in febrile neutropenic hosts. Since major pharmacokinetic changes have been reported for various classes of antibiotics in these patients, we advocate the need for adequate initial dosing regimens in all cases. Monitoring drug serum concentrations is mandatory for aminoglycosides and glycopeptides, and special attention should be paid to the dosing frequency of the short half-life beta-lactams to optimise the management of febrile neutropenia, especially in patients with severe sepsis.