The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

Principles of antimicrobial therapy in elderly patients

노인 환자의 항생제 치료 원칙

  • Kang, Cheol-In (Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 강철인 (성균관대학교 의과대학 삼성서울병원 감염내과)
  • Published : 2010.10.01
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Abstract

Older persons generally have greater susceptibility to infections than younger adults, probably because of the increased frequency of comorbidities and physiologic changes. There are many factors, both patient-related and treatment-related, which contribute to unique aspects of antimicrobial use in elderly persons that make prescribing complicated. Physiologic and pharmacokinetic changes associated with aging results in a higher risk of an adverse drug event and a harmful drug interaction, making antimicrobial dosing difficult. The risk of polypharmacy and more frequent adverse drug reactions in the elderly population justify a thorough consideration of the patient's true need for antimicrobial therapy. Given the increase in the elderly population and in the incidence of adverse drug reaction among elderly persons, further efforts should be made to optimize approach to management of infectious diseases in elderly persons.

Keywords

References

  1. Yoshikawa TT. Epidemiology and unique aspects of aging and infectious diseases. Clin Infect Dis 30:931-933, 2000 https://doi.org/10.1086/313792
  2. Faulkner CM, Cox HL, Williamson JC. Unique aspects of antimicrobial use in older adults. Clin Infect Dis 40:997-1004, 2005 https://doi.org/10.1086/428125
  3. Marangos MN, Skoutelis AT, Nightingale CH, Zhu Z, Psyrogiannis AG, Nicolau DP, Bassaris HP, Quintiliani R. Absorption of ciprofloxacin in patients with diabetic gastroparesis. Antimicrob Agents Chemother 39:2161-2163, 1995 https://doi.org/10.1128/AAC.39.9.2161
  4. Greenblatt DJ, Sellers EM, Shader RI. Drug therapy: drug disposition in old age. N Engl J Med 306:1081-1088, 1982 https://doi.org/10.1056/NEJM198205063061804
  5. Rowe JW, Andres R, Tobin JD, Norris AH, Shock NW. The effect of age on creatinine clearance in men: a cross-sectional and longitudinal study. J Gerontol 31:155-163, 1976 https://doi.org/10.1093/geronj/31.2.155
  6. McCusker J, Cole M, Dendukuri N, Belzile E, Primeau F. Delirium in older medical inpatients and subsequent cognitive and functional status: a prospective study. CMAJ 165:575-583, 2001
  7. Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivela SL, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol 55:809-817, 2002 https://doi.org/10.1016/S0895-4356(02)00411-0
  8. Jorgensen T, Johansson S, Kennerfalk A, Wallander MA, Svardsudd K. Prescription drug use, diagnoses, and healthcare utilization among the elderly. Ann Pharmacother 35:1004-1009, 2001 https://doi.org/10.1345/aph.10351
  9. Field TS, Gurwitz JH, Avorn J, McCormick D, Jain S, Eckler M, Benser M, Bates DW. Risk factors for adverse drug events among nursing home residents. Arch Intern Med 161:1629-1634, 2001 https://doi.org/10.1001/archinte.161.13.1629
  10. Gavazzi G, Krause KH. Ageing and infection. Lancet Infect Dis 2:659-666, 2002 https://doi.org/10.1016/S1473-3099(02)00437-1
  11. Nicholson SC, High KP, Gothelf S, Webb CD. Gatifloxacin in community-based treatment of acute respiratory tract infections in the elderly. Diagn Microbiol Infect Dis 44:109-116, 2002 https://doi.org/10.1016/S0732-8893(02)00458-3
  12. van den Brande P, van Steenbergen W, Vervoort G, Demedts M. Aging and hepatotoxicity of isoniazid and rifampin in pulmonary tuberculosis. Am J Respir Crit Care Med 152:1705-1708, 1995 https://doi.org/10.1164/ajrccm.152.5.7582317
  13. Baciewicz AM, Sokos DR, Cowan RI. Aminoglycoside-associated nephrotoxicity in the elderly. Ann Pharmacother 37:182-186, 2003 https://doi.org/10.1345/aph.1A395
  14. Gatell JM, Ferran F, Araujo V, Bonet M, Soriano E, Traserra J, SanMiguel JG. Univariate and multivariate analyses of risk factors predisposing to auditory toxicity in patients receiving aminoglycosides. Antimicrob Agents Chemother 31:1383-1387, 1987 https://doi.org/10.1128/AAC.31.9.1383
  15. Weber S, Mawdsley E, Kaye D. Antibacterial agents in the elderly. Infect Dis Clin North Am 23:881-898, viii, 2009 https://doi.org/10.1016/j.idc.2009.06.012