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Safety and Tolerability of Antimicrobial Agents in the Older Patient
Luca Soraci1, Antonio Cherubini2, Luca Paoletti2
1Unit of Geriatric Medicine, IRCCS INRCA, 87100, Cosenza, Italy.
Abstract:
Older patients are at high risk of infections, which often present atypically and are associated with high morbidity and mortality. Antimicrobial treatment in older individuals with infectious diseases represents a clinical challenge, causing an increasing burden on worldwide healthcare systems; immunosenescence and the coexistence of multiple comorbidities determine complex polypharmacy regimens with an increase in drug-drug interactions and spread of multidrug-resistance infections. Aging-induced pharmacokinetic and pharmacodynamic changes can additionally increase the risk of inappropriate drug dosing, with underexposure that is associated with antimicrobial resistance and overexposure that may lead to adverse effects and poor adherence because of low tolerability. These issues need to be considered when starting antimicrobial prescriptions. National and international efforts have been made towards the implementation of antimicrobial stewardship (AMS) interventions to help clinicians improve the appropriateness and safety of antimicrobial prescriptions in both acute and long-term care settings. AMS programs were shown to decrease consumption of antimicrobials and to improve safety in hospitalized patients and older nursing home residents. With the abundance of antimicrobial prescriptions and the recent emergence of multidrug resistant pathogens, an in-depth review of antimicrobial prescriptions in geriatric clinical practice is needed. This review will discuss the special considerations for older individuals needing antimicrobials, including risk factors that shape risk profiles in geriatric populations as well as an evidence-based description of antimicrobial-induced adverse events in this patient population. It will highlight agents of concern for this age group and discuss interventions to mitigate the effects of inappropriate antimicrobial prescribing.
Insights
Older adults face high infection risks and atypical symptoms, complicating antimicrobial treatment. This review details special considerations, adverse events, and interventions for safe antimicrobial prescribing in geriatric patients.
Area of Science:
- Geriatric Medicine
- Infectious Diseases
- Clinical Pharmacology
Background:
- Older patients are highly susceptible to infections, often presenting atypically, leading to significant morbidity and mortality.
- Aging alters drug metabolism and increases comorbidities, complicating antimicrobial therapy with risks of drug interactions, resistance, and adverse events.
- Antimicrobial stewardship (AMS) programs are crucial for optimizing antimicrobial use and safety in older populations.
Purpose of the Study:
- To review the unique challenges of antimicrobial prescribing in older adults.
- To discuss risk factors, pharmacokinetic/pharmacodynamic changes, and adverse events associated with antimicrobial use in geriatrics.
- To highlight key antimicrobial agents and interventions for improving geriatric antimicrobial therapy.
Main Methods:
- Literature review focusing on antimicrobial use in geriatric populations.
- Analysis of age-related changes in pharmacokinetics and pharmacodynamics.
- Examination of antimicrobial-induced adverse events and drug-drug interactions in older individuals.
Main Results:
- Infections in older adults present atypical symptoms and higher mortality risks.
- Pharmacokinetic and pharmacodynamic alterations in aging increase risks of inappropriate dosing, antimicrobial resistance, and adverse drug reactions.
- AMS interventions have demonstrated effectiveness in reducing antimicrobial consumption and improving patient safety in geriatric care settings.
Conclusions:
- Optimizing antimicrobial prescriptions in older adults requires careful consideration of age-specific factors and potential complications.
- Evidence-based strategies and antimicrobial stewardship are essential to mitigate risks and improve outcomes for geriatric patients requiring antimicrobial treatment.
- Further research and clinical guidelines are needed to address the complexities of antimicrobial prescribing in the growing elderly population.
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