Therapeutic problems in the management of elderly patients with tuberculosis

Adverse reactions to antituberculous drugs are more common in the elderly. With the increasing numbers of elderly people and the higher incidence of tuberculosis in this age group, clinicians will encounter more therapeutic problems in the use of antituberculous drugs than in younger patients. Existing studies regarding pharmacological and non-pharmacological factors which may predispose to increased adverse effects in the elderly are reviewed. Reduced clearances of isoniazid and rifampicin at steady state, possible increase in free drug concentration of drugs normally bound to albumin, possible differences in disposition of toxic metabolites such as hydrazine, concomitant administration of both isoniazid and rifampicin, poor nutrition and severity of the disease in the elderly may be contributing factors. Further studies in these areas should provide clearer guidelines on whether dosages or drug combinations should be modified in elderly patients with tuberculosis.