Antibiotic overuse contributes to the rise of superbugs, so experts have been calling on doctors to curb the liberal prescribing of antibiotics in many types of patients, including children with earaches and adults with sore throats.

Nursing homes often harbor drug-resistant bacteria, prior studies have shown, and residents can spread dangerous infections when they are admitted to hospitals.

Dr. Daniel Brauner, a geriatrician and ethicist at the University of Chicago Medical Center who was not involved in the study, said cautious use of antibiotics in nursing homes would require doctors to more closely monitor residents.

''But the standard of care (in nursing homes) is for doctors to see residents once a month, or once every two months,'' Brauner said. ''I'm sure a lot of these antibiotics were prescribed over the telephone.''

Doctors should discuss antibiotics with family, just as they would discuss placing a feeding tube, Mitchell said. None of the residents in the study who received antibiotics had living wills spelling out their wishes on antibiotic treatment, she said.

If the family's goal is to keep their loved one comfortable, rather than to prolong life, alternatives such as oxygen and Tylenol can help, she said.

Giving antibiotics is sometimes appropriate for such patients, she acknowledged.

''Maybe it's important for the family for the patient to live two weeks longer, or if they have a bad pneumonia and they're suffering and they're coughing,'' she said.

An accompanying editorial in the journal cautions that public policy limiting antibiotics to patients with advanced dementia would be ''ethically untenable.'' But the editorial calls on doctors to consider the public health ramifications when prescribing antibiotics to such patients.

Other experts disagreed.

''Until that decision is made that death is imminent, there's always hope,'' said Dr. Eric Tangalos, a geriatrician at Mayo Clinic in Rochester, Minn., who was not involved in the study. ''People do recover from those infections.''

Once called ''the old man's friend,'' pneumonia can be an acceptable end when a patient's quality of life is extremely low and everyone agrees the patient would want a dignified death, said another expert not involved in the study.

''You might rescue the patient from life-threatening pneumonia and they live a few days, weeks or even months longer,'' said Bruce Jennings, a bioethicist with the Hastings Center, a research institute on medical ethics. ''But the extra time you have bought them by that rescue is not beneficial.''

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Archives of Internal Medicine: http://www.archinternmed.com