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Antibiotics at the extremes of age: choices and constraints
1Public Health Laboratory, Royal United Hospital, Bath, UK.
Abstract:
Infection is a frequent cause of morbidity and mortality at the extremes of life. Its treatment is complicated by a lack of specificity in the clinical findings and wider range of pathogens than in other patients. For these reasons empirical therapy must cover a wide range of pathogens and yet, because the clinical findings may not even be due to infection, it should be as non-toxic as possible. It is also essential to investigate intensely before therapy so as to stand the best chance of making an aetiological diagnosis and possibly allowing a change to more directed therapy. Neonates in particular, but also the elderly, are susceptible to age-associated antibiotic toxicities, such as those from tetracyclines and chloramphenicol. Polypharmacy in the elderly renders them particularly liable to drug interactions. Both age groups have altered pharmacokinetics of antibiotics, including differences in absorption, distribution and elimination compared with healthy adults, and therapeutic drug monitoring may be needed more frequently as a result.
Insights
Treating infections in neonates and the elderly requires careful antibiotic selection due to unique pathogen profiles and altered drug metabolism. Empiric therapy must balance broad coverage with minimal toxicity, necessitating thorough diagnostics and potential therapeutic drug monitoring.
Area of Science:
- Infectious Diseases
- Pharmacology
- Geriatrics
- Neonatology
Background:
- Infections pose significant risks for neonates and the elderly, contributing to morbidity and mortality.
- Clinical presentation of infections in these age groups lacks specificity, complicating diagnosis.
- A broad spectrum of potential pathogens requires consideration in treatment strategies.
Purpose of the Study:
- To outline challenges in treating infections in neonates and the elderly.
- To emphasize the need for careful selection of empirical antibiotic therapy.
- To highlight the importance of diagnostic investigation and potential for targeted therapy.
Main Methods:
- Review of existing literature on infection management in extreme age groups.
- Analysis of pharmacokinetic and pharmacodynamic differences in neonates and the elderly.
- Discussion of age-associated antibiotic toxicities and drug interactions.
Main Results:
- Neonates and the elderly exhibit altered antibiotic pharmacokinetics (absorption, distribution, elimination).
- These age groups are more susceptible to specific antibiotic toxicities (e.g., tetracyclines, chloramphenicol).
- Polypharmacy in the elderly increases the risk of drug interactions.
Conclusions:
- Empirical antibiotic therapy for neonates and the elderly must be broad-spectrum yet non-toxic.
- Intensive diagnostic workup is crucial for etiological diagnosis and de-escalation of therapy.
- Therapeutic drug monitoring may be necessary due to altered drug metabolism and elimination in these populations.