Antibiothérapie du sujet âgé : On peut toujours mieux faire

Area of Science:

• Geriatric Medicine
• Infectious Diseases
• Clinical Pharmacology

Background:

• Antimicrobials are frequently prescribed to elderly individuals, with usage increasing due to age-related frailty and higher infection risks.
• Prescribing antimicrobials in the elderly requires careful consideration of both toxicity from overexposure and treatment failure or resistance from under-dosage.

Purpose of the Study:

• To review the key variations in antimicrobial pharmacokinetics and pharmacodynamics influenced by aging.
• To examine the impact of comorbidities and polypharmacy on antimicrobial efficacy and safety in older adults.
• To provide guidance on optimizing antimicrobial prescribing for the elderly population.

Main Methods:

• Literature review of studies on antimicrobial pharmacokinetics and pharmacodynamics in aging populations.
• Analysis of factors including comorbidities and polypharmacy affecting drug response.
• Synthesis of evidence to inform best practices for antimicrobial selection and dosing in elders.

Main Results:

• Aging significantly alters drug absorption, distribution, metabolism, and excretion, impacting antimicrobial efficacy and toxicity.
• Comorbidities and polypharmacy introduce complex drug interactions and physiological changes that necessitate individualized dosing strategies.
• Under-dosing can lead to treatment failure and antimicrobial resistance, while over-dosing increases the risk of adverse events in elderly patients.

Conclusions:

• Optimizing antimicrobial therapy in the elderly requires a comprehensive understanding of age-related physiological changes and patient-specific factors.
• Tailoring antimicrobial prescriptions based on pharmacokinetic and pharmacodynamic principles is essential to ensure treatment success and minimize harm.
• Further research is needed to refine dosing guidelines and therapeutic strategies for antimicrobial use in geriatric populations.