Antibiotic use in the elderly: issues and nonissues.

Despite the well-recognized increase in mortality and morbidity due to infections in the elderly, antibiotics may, in most cases, be used in a manner similar to that in younger patients. The decreased lean body weight and reduced renal function typical of elderly patients, however, require consideration of reduced doses and longer dosing intervals, especially for renally excreted antibiotics. Length of therapy should be conservative because underlying anatomic or functional predispositions to infections tend to complicate treatment. Oral antibiotics are equally well absorbed in the elderly and younger patients and may be used for the same indications as for younger patients. A notable, important difference in the choice of antibiotics for serious infections in older versus younger patients is that empirical therapy should be broader in spectrum for elderly patients, and especially for elderly long-term residents, since the variety of infecting bacteria tends to be greater and polymicrobial infections tend to be common.