[Application of antibiotics in vulnerable groups]

Antibiotics are substances that possess bacteriostatic or bactericidal effect. Their administration is widespread in the treatment as well as in the prevention of many infections in general population, and especially in vulnerable groups.

Respiratory and urinary infections are the most common infections in the elderly. The initial empirical antibiotic therapy of pneumonia in older patients is directed to possible causative agents. Doxicicline is most frequently applied in ambulatory patients, followed by macrolides (azithromycin), fluorochinolone and amoxicillin with clavulanic acid. In the hospitalized patients, a wide spectrum of cephalosporins with macrolides is applied, as well as beta-lactamase inhibitors combined with macrolides or fluorochinolone only. Asymptomatic bacteriuria, a very common phenomenon in the elderly, is usually not treated. The antibiotic therapy of urinary infection in the older population is applied according to the causative agent. Polymicrobial infections occur in 30% of the patients, more often in those with urinary catheter. The wide spectrum antibiotics, especially cotrimoxazole and chinolone are applied in such cases.

In the HIV infected and AIDS suffering patients, antibiotics are used as a means of prophylaxis and treatment of the opportunistic infections. They occur during the terminal stage of illness, although they might be the first manifestation of the HIV illness. The treatment of the opportunistic infections in HIV/AIDS patients assumes the primary prophylaxis, then treatment of acute manifestations and the secondary prophylaxis. The aim of the treatment in this category is to prevent several opportunistic infections with a single antibiotic--the so called multiple prophylaxis.

There are no general rules defining the choice of antibiotics for vulnerable groups, hence each and every patient should be considered as a separate individual and the most efficient antibiotic or a combination of antibiotics ant their optimal dosage should be selected taking into consideration all available facts.