Introduction: Pneumonia is a common occurrence at the end of life (EOL). However, clear definitions and consensual guidelines for managing this condition are lacking. Diagnosing EOL pneumonia and deciding whether to treat it with antibiotics can be challenging.

Area covered: This special report provides a narrative review of epidemiological data, diagnostic tools for EOL pneumonia, guidance on antibiotic use, and ethical considerations in this context. Literature from 2000 to 2024 was analyzed using PubMed and Cochrane databases.

Expert opinion: At the EOL, respiratory symptoms must be managed to improve patients' quality of life. Bacterial pneumonia can be difficult to diagnose, and the benefits of antibiotics on respiratory symptoms remain uncertain. At an individual level, adverse events may impact EOL quality, while at a population level, overprescribing antibiotics contributes to antimicrobial resistance. A multidisciplinary approach is therefore essential. Treatment goals should be established with the patient or their healthcare representative. If antibiotics are prescribed, they should be initiated for a limited duration with daily reassessments. If the set goals are not achieved or if adverse events occur, antibiotics should be discontinued. Palliative care measures should also be introduced as early as possible.