Marco Falcone1, Mical Paul2, Giusy Tiseo3, Dafna Yahav4, Virginie Prendki5, Lena E Friberg6, Roberto Guerri7, Gaetan Gavazzi8, Cristina Mussini9, Marco Tinelli10. 1. Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, Pisa 56124, Italy. Electronic address: marco.falcone@unipi.it. 2. Division of Infectious Diseases, Rambam Health Care Center and The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. 3. Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, Pisa 56124, Italy. 4. Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel. 5. Division of Internal Medicine of the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Hôpital des Trois-Chêne, Geneva, Switzerland. 6. Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden. 7. Infectious Diseases Department, Hospital del Mar, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. 8. University Clinics of Geriatrics, University Hospital of Grenoble-Alpes, GREPI EA7408 University of Grenoble Alpes, Grenoble, France. 9. Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy. 10. Division of Infectious and Tropical Diseases, Hospital of Lodi, Lodi, Italy.
Abstract
OBJECTIVES: To maximise efficacy and minimise toxicity, special considerations are required for antibiotic prescription in elderly patients. This review aims to provide practical suggestions for the optimal management of antibiotic therapy in elderly patients. METHODS: This was a narrative review. A literature search of published articles in the last 15 years on antibiotics and elderly patients was performed using the Cochrane Library and PubMed electronic databases. The three priority areas were identified: (i) pharmacokinetics/pharmacodynamics (PK/PD) for optimising dosage regimens and route of administration; (ii) antibiotic dosages in some special subpopulations; and (iii) treatment considerations relating to different antibiotic classes and their adverse events. RESULTS: Clinicians should understand the altered PK/PD of drugs in this population owing to co-morbid conditions and normal physiological changes associated with ageing. The body of evidence justifies the need for individualised dose selection, especially in patients with impaired renal and liver function. Clinicians should be aware of the major drug-drug interactions commonly observed in the elderly as well as potential side effects. CONCLUSION: Antibiotic therapy in the elderly requires a comprehensive approach, including strategies to improve appropriate antibiotic prescribing, limit their use for uncomplicated infections and ensure the attainment of an optimal PK/PD target. To this purpose, further studies involving the elderly are needed to better understand the PK of antibiotics. Moreover, it is necessary to assess the role therapeutic drug monitoring in guiding antibiotic therapy in elderly patients in order to evaluate its impact on clinical outcome.
OBJECTIVES: To maximise efficacy and minimise toxicity, special considerations are required for antibiotic prescription in elderly patients. This review aims to provide practical suggestions for the optimal management of antibiotic therapy in elderly patients. METHODS: This was a narrative review. A literature search of published articles in the last 15 years on antibiotics and elderly patients was performed using the Cochrane Library and PubMed electronic databases. The three priority areas were identified: (i) pharmacokinetics/pharmacodynamics (PK/PD) for optimising dosage regimens and route of administration; (ii) antibiotic dosages in some special subpopulations; and (iii) treatment considerations relating to different antibiotic classes and their adverse events. RESULTS: Clinicians should understand the altered PK/PD of drugs in this population owing to co-morbid conditions and normal physiological changes associated with ageing. The body of evidence justifies the need for individualised dose selection, especially in patients with impaired renal and liver function. Clinicians should be aware of the major drug-drug interactions commonly observed in the elderly as well as potential side effects. CONCLUSION: Antibiotic therapy in the elderly requires a comprehensive approach, including strategies to improve appropriate antibiotic prescribing, limit their use for uncomplicated infections and ensure the attainment of an optimal PK/PD target. To this purpose, further studies involving the elderly are needed to better understand the PK of antibiotics. Moreover, it is necessary to assess the role therapeutic drug monitoring in guiding antibiotic therapy in elderly patients in order to evaluate its impact on clinical outcome.
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