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Antibiotic use in the elderly: issues and nonissues
1University of Massachusetts Medical School and the Department of Medicine, Berkshire Medical Center, Pittsfield 01201, USA. drjmccue@massmed.org
Abstract:
Despite the well-recognized increase in mortality and morbidity due to infections in the elderly, antibiotics may, in most cases, be used in a manner similar to that in younger patients. The decreased lean body weight and reduced renal function typical of elderly patients, however, require consideration of reduced doses and longer dosing intervals, especially for renally excreted antibiotics. Length of therapy should be conservative because underlying anatomic or functional predispositions to infections tend to complicate treatment. Oral antibiotics are equally well absorbed in the elderly and younger patients and may be used for the same indications as for younger patients. A notable, important difference in the choice of antibiotics for serious infections in older versus younger patients is that empirical therapy should be broader in spectrum for elderly patients, and especially for elderly long-term residents, since the variety of infecting bacteria tends to be greater and polymicrobial infections tend to be common.
Insights
Antibiotic therapy for elderly patients generally mirrors that for younger individuals, with dose adjustments for reduced kidney function. Empirical antibiotic therapy for serious infections in older adults requires a broader spectrum due to increased bacterial diversity and polymicrobial infections.
Area of Science:
- Geriatrics
- Infectious Diseases
- Pharmacology
Background:
- Elderly populations face increased mortality and morbidity from infections.
- Standard antibiotic use in older adults requires careful consideration of physiological changes.
Purpose of the Study:
- To outline appropriate antibiotic use in elderly patients.
- To highlight key differences in antibiotic selection and dosing for geriatric patients.
Main Methods:
- Review of current literature on antibiotic pharmacokinetics and pharmacodynamics in the elderly.
- Analysis of infection patterns and treatment considerations in older adults.
Main Results:
- Antibiotic absorption is similar in elderly and younger patients; oral antibiotics can be used for similar indications.
- Reduced lean body weight and renal function necessitate dose reduction and longer intervals for renally excreted antibiotics.
- Conservative therapy length is advised due to complicating predispositions to infection.
Conclusions:
- Antibiotic therapy in the elderly is largely similar to younger patients, with crucial dose and interval adjustments.
- Broader-spectrum empirical therapy is essential for serious infections in older adults, particularly long-term residents, due to diverse and polymicrobial infections.