ANTIMICROBIAL THERAPY IN THE ELDERLY

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The approach to antibiotic use in elderly patients is a unique and challenging problem. Older patients often suffer more serious complications of infection. Approximately one third of persons older than age 80 and a higher percentage of elderly disabled persons reside in long-term care facilities; bacterial flora in such institutions remain intermediate between the relatively antibiotic-resistant hospital flora and the flora typical of community-acquired infections. The rapid emergence of resistant microorganisms and the development of new classes of antimicrobial agents present potential diagnostic dilemmas and therapeutic challenges to treating clinicians.

This article focuses on the special characteristics of infection in the elderly and provides an update of the principles of antibiotic selection, use of specific antibiotics, and empiric use of antimicrobials in the treatment of infectious diseases in this particularly vulnerable group. Antituberculous, antifungal, and antiviral agents are mentioned only briefly; detailed information regarding these classes of agents in reference to aging can be found in standard reviews of antimicrobial therapy in the elderly.

Section snippets

UNIQUE CONSIDERATIONS IN THE ELDERLY

Infectious diseases in older persons compared with younger individuals are relatively more frequent and severe.44 The elderly also suffer greater complications of these infections, which eventually contribute to a higher mortality. Infections in aging adults that are associated with increased morbidity include pneumonia, often complicated by bacteremia, extrapulmonary sites of infection, delayed resolution, and pulmonary function compromise; tuberculosis infection and disease, which is prone to

PRINCIPLES OF ANTIBIOTIC THERAPY

When selecting antibiotics for a specific infection in the elderly patient, the unique problems and issues mentioned earlier must be taken into consideration. Because of the high risk of complications and death resulting from infections, the diverse infectious causes, and the difficulty in obtaining diagnostic specimens, initial empiric antibiotic therapy selection for specific infections is a valid and practical option.19 The empiric use of antibiotics for specific infections in the elderly is

USE OF SPECIFIC ANTIBIOTICS

This discussion focuses on specific classes of antibiotics that are particularly relevant and important for the treatment of bacterial infections in the aging patient.

EMPIRIC USE OF ANTIBIOTICS

The empiric selection of antibiotics should take into consideration the most likely sites and causes of infection, clinical status of the patient, comparative efficacy of antibiotics that could be selected under similar circumstances, potential adverse effects of the drugs, and overall costs incurred in use of the drug.66 The empiric antibiotic regimen ideally should be subsequently replaced by a more focused regimen based on microbiologic data that indicate a specific cause, when possible

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      These factors will determine whether the therapy should be administered orally or parenterally. MSRA and streptococci are treated with first-generation cephalosporins, antistaphylococcal penicillins, and clindamycin in penicillin allergic patients [16,18]. Polymicrobial infections frequently occur in decubiti and diabetic ulcerations.

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    Address reprint requests to Shobita Rajagopalan, MD, Department of Internal Medicine, MP 11, Charles R. Drew University of Medicine and Science, King-Drew Medical Center, 12021 S. Wilmington Avenue, Los Angeles, CA 90059. e-mail: [email protected]

    *

    Department of Internal Medicine, Division of Infectious Disease, Charles R. Drew University of Medicine and Science, King-Drew Medical Center, Los Angeles, California

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