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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Principles of antibiotic prescribing in the elderly
1Department of Medicine, Boston University School of Medicine, Carney Hospital, Massachusetts, USA.
Abstract:
Clinicians providing care to elderly patients must appreciate the subtle clinical manifestations that herald the onset of life-threatening infectious disease. Aged patients with an infection may have neither fever nor leucocytosis, making diagnosis challenging. Often, the early features of infectious disease are nonspecific and may resemble inflammatory or neoplastic processes, or there may be insufficient time to await definitive laboratory confirmation, and empirical antimicrobial treatment must be initiated. Aging involves inevitable deleterious alterations in biological processes and, in many elderly patients, this is most strongly characterised by diminished renal functional capacity. This has a major influence on antimicrobial prescribing in the elderly, because therapeutic efficacy must be achieved while minimising the risk of drug-related toxicity. Before prescribing an antibiotic to an aged patient with an infection, the clinician must be cognisant of the patient's drug allergy history and the other drugs that the patient is taking. Ignorance of potential drug-drug interactions can result in ineffective treatment or enhanced toxicity. The therapy of elderly patients with infections is being expanded. To reduce costs and enhance the efficiency of care, systems have been developed to provide antimicrobial care in the home and in long term care facilities. Home healthcare has burgeoned, and drugs that are well tolerated, have a broad spectrum of activity and are simple to administer (e.g. ceftriaxone and fluoroquinolones) appear to be eminently suitable for this therapeutic role. Physicians must also be informed of the factors responsible for the emergence of resistant bacteria that are contributing to infections in institutional and community settings. Clinicians should strive to curb inappropriate antibiotic use to stem the tide of infections that are caused by multidrug-resistant bacteria.
Insights
Treating infections in elderly patients requires careful antibiotic selection due to altered physiology and potential drug interactions. Optimizing antimicrobial therapy in older adults is crucial for efficacy and safety, especially with rising antimicrobial resistance.
Area of Science:
- Geriatrics
- Infectious Diseases
- Clinical Pharmacology
Background:
- Elderly patients often present with atypical infectious disease symptoms, lacking fever or elevated white blood cell counts, complicating diagnosis.
- Aging-associated physiological changes, particularly diminished renal function, significantly impact antimicrobial drug dosing and toxicity risk.
- Co-prescribing and potential drug-drug interactions in older adults necessitate careful medication review before initiating antibiotic therapy.
Purpose of the Study:
- To highlight the challenges and considerations for prescribing antibiotics in elderly patients.
- To emphasize the importance of individualized antimicrobial therapy in older adults.
- To discuss the evolving landscape of antimicrobial care delivery in geriatric populations.
Main Methods:
- Review of clinical manifestations of infections in the elderly.
- Analysis of pharmacokinetic and pharmacodynamic alterations in aging.
- Examination of drug interaction profiles and toxicity risks associated with common antibiotics.
- Evaluation of home healthcare and long-term care facility models for antimicrobial administration.
Main Results:
- Infections in the elderly may present with subtle, nonspecific signs, mimicking other conditions and delaying diagnosis.
- Renal functional capacity in the elderly directly influences antimicrobial efficacy and safety, requiring dose adjustments.
- Appropriate antibiotic selection and administration, considering drug allergies and interactions, are paramount for successful treatment.
- Home-based and long-term care facility antimicrobial delivery models are expanding, favoring well-tolerated, broadly active, and easily administered agents.
Conclusions:
- Antimicrobial prescribing for elderly patients demands a thorough understanding of age-related physiological changes and potential drug interactions.
- Tailored antimicrobial strategies are essential to balance therapeutic effectiveness with minimized toxicity in older adults.
- Combating multidrug-resistant bacteria necessitates informed antibiotic use and strategies to curb inappropriate prescribing in all care settings.
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