[Selection of antibacterial therapy for treatment of infections in elderly patients]
Iu B Belousov1, V P Komarova, O V Efremenkova
1Russia State Medical University, Moscow.
Abstract:
Examination of 60 elderly outpatients with lower respiratory tract infections (LRTI) revealed that 73 per cent of the patients isolated the pathogen associations and only 27 per cent isolated the monocultures. Grampositive cocci including Streptococcus pneumoniae were isolated from 70 per cent of the patients, Haemophilus influenzae and H.parainfluenzae were isolated from 20 per cent of the patients and Acinetobacter spp., Citrobacter spp., Enterobacter spp., Proteus spp. and Pseudomonas aeruginsa were isolated from 10 per cent of the patients. The patients were treated with ciprofloxacin, cefaclor or amoxycillin/clavulanic acid. Ciprofloxacin proved to be the most efficient agent. The regimens of the ofloxacin use in a dose of 400 mg orally once a day or in a dose of 200 mg intravenously twice a day for 2-4 days followed by the oral use for 6-8 days in the treatment of 24 patients with LRTI hospitalized into a therapeutic unit were compared. it was shown (pharmacokinetically as well) that the regiment with the drug use in the single dose was more efficient. Lomefloxacin was suggested to be the most advantageous drug in the treatment of elderly patients with LRTI because of its easy use, practically no dependence of the pharmacokinetics on the patient age and almost no nephrotoxic action.
Insights
In elderly patients with lower respiratory tract infections (LRTI), pathogen associations were common. Ciprofloxacin demonstrated high efficacy, and lomefloxacin emerged as a preferred treatment due to its safety and ease of use in older adults.
Area of Science:
- Geriatrics
- Infectious Diseases
- Pharmacology
Background:
- Lower respiratory tract infections (LRTI) are common in elderly patients.
- Understanding the microbial etiology of LRTI in this population is crucial for effective treatment.
- Antibiotic resistance and age-related pharmacokinetic changes necessitate careful drug selection.
Purpose of the Study:
- To investigate the pathogens causing LRTI in elderly outpatients.
- To compare the efficacy of different antibiotic treatments for LRTI in the elderly.
- To evaluate the optimal dosing regimen for ofloxacin and the suitability of lomefloxacin in elderly patients with LRTI.
Main Methods:
- Retrospective analysis of 60 elderly outpatients with LRTI.
- Microbiological examination to identify causative pathogens (monocultures vs. associations).
- Comparison of antibiotic treatments including ciprofloxacin, cefaclor, amoxycillin/clavulanic acid, ofloxacin, and lomefloxacin.
Main Results:
- Pathogen associations were identified in 73% of patients; monocultures in 27%.
- Common pathogens included Streptococcus pneumoniae, Haemophilus influenzae, and various Gram-negative bacteria.
- Ciprofloxacin was the most effective single agent; a once-daily ofloxacin regimen was superior.
- Lomefloxacin showed favorable pharmacokinetics, age independence, and low nephrotoxicity.
Conclusions:
- Polymicrobial infections are prevalent in elderly patients with LRTI.
- Ciprofloxacin is highly effective, and once-daily ofloxacin offers an efficient treatment strategy.
- Lomefloxacin is a highly advantageous option for treating LRTI in the elderly due to its favorable safety and pharmacokinetic profile.
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