Subcutaneous Ertapenem and Temocillin for Symptom Control of Pelvic Collection in the Palliative Care Setting: A Case Report.

Infections can significantly impair quality of life in patients with life-limiting disease, yet antibiotics are infrequently used for symptom control in palliative care due to challenges in administration, concerns about antimicrobial resistance, and limited clinical guidance. Emerging evidence and pharmacokinetic data support the subcutaneous route as a viable option for delivering several antibiotics. We present a female patient in her 50s with an incurable presacral collection secondary to rectosigmoid adenocarcinoma who presented with fever, pain, and rectal discharge refractory to initial management. Subcutaneous ertapenem, followed by temocillin, resulted in marked symptomatic improvement and was well tolerated with infusion rate adjustments.  This intervention led to a significant improvement in quality of life, enabling over four months at home and the achievement of important personal milestones. This case highlights the potential role of subcutaneous antibiotics for symptom control in palliative care and underscores the need for further consensus guidance.