about the project
Medical news
For authors
Licensed books on medicine
<< Previous Next >>

The use of anti-infective chemotherapy drugs in the elderly

The high incidence of infectious pathology in the elderly, along with its unfavorable prognosis, justifies the widespread use of AMP in them. The latter are one of the most frequently prescribed (about 40%) drugs in specialized departments of extended stay of elderly patients. However, the appointment of AMP in older age groups is not always clinically justified.

Decision-making on the appointment of AMS to the elderly requires mandatory consideration of the characteristics of this age group:

age-related morphological and functional changes in various organs and tissues;

polymorbidity (the presence of two or more diseases);

chronic course of many diseases;

drug therapy, requiring the use of (often prolonged) several drugs (forced polypharmacy);

features of the clinical manifestations of infection;

more frequent and severe drug complications;

features of psychosocial status.

The choice of AMP in older people is determined by various factors, the most important of which are discussed below.

A rough definition of the etiology of infection is the most important criterion in the choice of AMP. This is due to the need to start therapy as early as possible, which is associated with a high risk of rapid progression of infectious inflammation, the development of complications, frequent decompensation of concomitant pathology, and an unfavorable prognosis of the disease. For example, mortality in the first 30 days in patients older than 65 years with severe pneumonia, in whom antibiotic therapy was started in the first 8 hours from the time of admission, was significantly lower compared with patients who were used for AMP at a later date.

Clinical manifestations of infection in elderly patients may be atypical, nonspecific or even absent. One of the features of the clinical manifestations of geriatric infection is the frequent absence of fever, the presence of cognitive impairment, sudden onset of confusion, and the mild local symptoms of the infection. Often, the clinical symptoms of infection in the elderly, in particular with infections of the MEP, are generally absent.

In the elderly, there are some features of the etiology of infections. So, if the causative agents of community-acquired pneumonia in the general population is a fairly limited spectrum of microorganisms (S. pneumoniae, H. influenzae, M. pneumoniae and C. pneumoniae), then in elderly people, along with the above bacteria, the causative agents of the disease can be enterobacteria and P. aeruginosa.

Older people represent the highest risk group for tuberculosis, not counting patients with HIV infection. Tuberculosis mortality also increases with age. Its level in the elderly is 10 times higher than in the young.

The most typical geriatric infections are infections of MVP, mortality from which in the elderly is 5-10 times higher than in the young. In contrast to people of a younger age, in whom MVP infections occur mainly in sexually active women, among older people this infection is observed in patients of both sexes. The main causative agents of MVP infections are E. coli, Proteus spp., Other enterobacteria, less commonly Enterococcus spp., S.aureus. Most cases of MVP infections in the elderly are secretive, asymptomatic bacteriuria is often detected, which causes difficulties in interpreting and deciding on the appropriateness of antibiotic therapy.

Special situations in geriatric practice are infections in people living in nursing homes. Approximately 75% of all infections in them are pneumonia, infections of MVP, infections of the skin and soft tissues.

The spectrum of pneumonia pathogens in people living in boarding schools includes S. pneumoniae (12.9%), H. influenzae (6.4%), S. aureus (6.4%), M. catarrhalis (4.4%) , family Enterobacteriaceae (13.1%). The etiology of pneumonia in this contingent is not always possible to determine, due to the frequent impossibility of obtaining an adequate sputum sample for research. Another problem is the difficulty in distinguishing between microbial colonization by aerobic gram-negative microorganisms and true infection. It is known that the frequency and degree of colonization of the oropharynx by gram-negative microorganisms increases with age.

The pharmacokinetic properties of AMP in the elderly may vary due to concomitant diseases with the presence of functional disorders of the kidneys and liver. Along with manifest pathologies (CRF, impaired liver function, etc.), age-related changes in the kidneys and liver that affect the metabolism and elimination of AMP should also be taken into account.
It is known that with age, a decrease in glomerular filtration occurs, which should be considered when prescribing AMP excreted by the kidneys. When choosing AMP in elderly patients with concomitant chronic renal failure, it is preferable to prescribe drugs metabolized in the liver (macrolides, metronidazole) or having a double elimination pathway (cefoperazone). For AMP with renal excretion, it is necessary to reduce the dose in proportion to the decrease in glomerular filtration.

The pharmacokinetic interaction of AMP with other drugs is of particular importance in the elderly, receiving several drugs due to their often associated pathology (calcium, iron, NSAIDs, theophylline, etc.). For example, the absorption of fluoroquinolones may be impaired in elderly patients receiving iron, aluminum, magnesium, calcium preparations in connection with concomitant pathology.

Pharmacotherapy compliance. In people of advanced and senile age, it is preferable to use AMP prescribed 1-2 times a day. This is especially true for injectable drugs, since it provides not only a convenient dosage regimen, but also reduces the risk of post-injection complications (phlebitis, hematomas). A single or double oral administration of AMP contributes to greater compliance of elderly patients, who, due to impaired memory, vision and often lack of extraneous control, have problems observing the prescribed intake regimen.

AMP resistance in older people is more common than in young people. This is facilitated by the polymorbidity of the elderly, the more frequent preceding antibiotic therapy, especially in patients with repeated infectious exacerbations of COPD or recurrent infections of MVP and, finally, living in boarding houses. The widespread and often unreasonable use of AMP contributes to the formation of resistance not only to "old", but also to relatively recent drugs, for example, fluoroquinolones. Therefore, when choosing AMP for empirical therapy, one should take into account the local epidemiology of antibiotic resistance that has developed in the region, hospital, department.

The safety of AMP is of particular importance in elderly patients in connection with concomitant, often multiple, diseases. Thus, in senile people, the nephrotoxic and ototoxic effects of aminoglycosides, the nephrotoxic effect of high doses of cephalosporins are more often recorded, and the appointment of cotrimoxazole is associated with a higher risk of neutropenia. It is advisable to reduce the dose of AMP in patients with a pronounced decrease in body weight, especially in women. When prescribing AMP excreted by the kidneys, a dose adjustment is necessary taking into account creatinine clearance, which decreases after 30 years of life by 1 ml / min annually. Caution should be prescribed to the elderly or, if possible, avoid the use of aminoglycosides, amphotericin B, vancomycin.

In order to ensure greater safety, it is more preferable to administer AMP inward or timely switch from the parenteral route of administration to the oral route (stepwise therapy).

The criteria for the transition from the parenteral route of administration to oral AMP should be considered normal indicators of body temperature with a 2-fold measurement over the past 16 hours, a tendency to normalize the number of leukocytes, subjective improvement in well-being, and the absence of signs of malabsorption. The optimal time for switching from parenteral to oral therapy is 48-72 hours. Usually they switch to the oral form of the same AMP, however, it is possible to use a drug that is similar in activity spectrum to parenteral AMP. For example, if ampicillin was administered parenterally, amoxicillin is given orally. To ensure high compliance, preference should be given to AMP with good bioavailability and a convenient dosage regimen (1-2 times a day). Such fluoroquinolones, in particular levofloxacin, can meet these requirements. Currently, there are numerous data on the high clinical and microbiological effectiveness of levofloxacin in the framework of step therapy, comparable to ceftriaxone and superior to the combination of ceftriaxone or cefuroxime axetil in combination with erythromycin or doxycycline in the treatment of severe community-acquired pneumonia.

The cost of ILA, all other things being equal, is of no small importance for the elderly. At the same time, evaluating their financial capabilities, the doctor should be aware that the use of cheaper drugs can often lead to an insufficient effect, a protracted course, the development of complications and, ultimately, the treatment is more expensive. Ultimately, the most expensive AMP is one that has no effect.
<< Previous Next >>
= Skip to textbook content =

The use of anti-infective chemotherapy drugs in the elderly

  1. The use of anti-infective chemotherapy drugs during pregnancy and lactation
    The rational and effective use of antibiotics during pregnancy involves the following conditions: • it is necessary to use drugs only with established safety during pregnancy, with known metabolic pathways (FDA criteria); • when prescribing drugs, pregnancy should be considered: early or late. Since the deadline for final completion
  2. Features of the use of anti-infective chemotherapy drugs in different groups of patients
    Features of the use of anti-infective chemotherapy drugs in different groups
  3. The use of anti-infective chemotherapy drugs in patients with renal and hepatic insufficiency
    In case of impaired liver function, the main metabolizing organ, inactivation of certain antibiotics (macrolides, lincosamides, tetracyclines, etc.) can significantly slow down, which is accompanied by an increase in the concentration of drugs in blood serum and an increased risk of toxic effects. In addition, in conditions of liver failure, the risk of undesirable effects of such AMP
  4. Prevention of sudden cardiac death in the elderly
    Artificial cardioverter-defibrillator should not be used in elderly people whose life expectancy in connection with underlying or concomitant diseases is less than 1 year. To reduce the overall mortality in elderly people, it is necessary to use blockers more actively.
    In elderly people, the frequency of infections with MEP is significantly increased, which is associated with complicating factors: benign prostatic hyperplasia in men and a decrease in estrogen levels in women during menopause. Therefore, the treatment of infections of MVP should include not only the use of AMP, but also the correction of the described risk factors. With benign prostatic hyperplasia
    In the elderly, renal function is often reduced, which requires special care when using aminoglycosides. It should be remembered that in such patients, vancomycin elimination is slowed down (half-life is 7.5 days). There is also a high frequency of HP when used
  7. Meaningful life orientations of elderly people
    Nikolai Zabolotsky has a line: How the world is changing! And how I myself am changing! Only by one name I am called, -In fact, what they call me, -Not I alone. There are a lot of us. I'm alive. Meaningful life orientations, like any mental formations, have their own dynamics. In the process of a person’s life, life-meaning orientations change in content, emotional coloring, and regulatory contribution to
    The general principles of prescribing medicines for the elderly do not differ from those for other age groups, however, the use of the drug in lower doses is usually required (Bezrukov V., L. Kuprash, 2005). In patients of this age category, adverse reactions during pharmacotherapy develop in general more often than in other age groups (table. 4.1). Last connected
  9. Clinical and pharmacological characteristics of anti-infectious chemotherapy drugs.
    General features of anti-infectious chemotherapy Anti-infectious chemotherapy (drugs) represent the largest group of drugs. So, in Russia only 30 different groups of antibiotics are currently used, and the total number of AMPs (excluding generics) is approaching 200. The division of anti-infective drugs into groups according to predominant activity is based on
  10. The choice of anti-infectious chemotherapy for various diseases
    The choice of anti-infectious chemotherapy for various
    The human immunodeficiency virus belongs to the subfamily of lentiviruses of the retrovirus family. Two types of virus are distinguished, differing in the structure of the genome and serological characteristics: HIV-1 and HIV-2. In the world, according to various estimates, from 30 to 50 million people are infected with HIV, and it is expected that most of them will die within the next 10 years, while each is likely to infect a few
  13. Macrobiotics and old age
    Macrobiotics believes that old age begins with 70 years. For those who, from a young age, in the middle years and at a later age, live in harmony with the laws of the Universe, there is no need for a special diet. They can eat anything. Everything can be used in the macrobiotic sense of the world: Yin-Yang, who has lived for many years in dynamic equilibrium, is able to perfectly control himself. Its tall
    {foto62} Whatever life teaches us, But the heart believes in miracles. There is non-decreasing power, There is imperishable beauty. And the withering earthly Flowers will not touch the unearthly, And from the midday heat the Dew will not dry out on them. And this faith will not deceive the One who only lives by it, Not everything that flourished here will fade, Not everything that was here will pass! But this faith is for few
  15. Nutrition in old age and old age
    According to the age classification approved by the Congress of Gerontologists and Geriatricians, the population over 60 years old is divided into three age categories: elderly people - from 61 years old to 74 years old; persons of senile age - 75 years and older, long-livers - 90 years and older. Aging is a slow process of accumulation of age-related changes manifesting at all levels of the whole organism. TO
  16. AH in the elderly.
    The results of randomized trials suggest that antihypertensive therapy reduces the risk of CVD and mortality in elderly patients with systolic-diastolic hypertension and ISAG. The principles of treatment for elderly patients with hypertension are the same as in the general population. Treatment should begin with lifestyle changes. Limiting consumption of salt and weight loss in this category of patients have
  17. Features of anesthesia in the elderly and senile
    According to the WHO definition, men and women who have reached the age of over 65 years are considered to be elderly, the period of old age is from 75 to 90 years, over 90 years are long-livers. Of particular importance to the anesthetist are age-related changes in basal metabolism, decreased compensatory and adaptive capabilities of the cardiovascular and respiratory systems, and liver and kidney function. To 70 years
  18. Features of nutrition of the elderly
    In connection with the transition of the economy of our country to market relations at the end of the 20th century, the most important demographic indicators of the population sharply worsened: fertility, life expectancy, mortality, indicators of the physical development of the younger generation, which was due to a significant decrease in the standard of living of the bulk of the population. Already there is a sharp aging of the population, as in
  19. Features of the course and management of the postoperative period in elderly and senile patients
    Most women undergoing surgical surgical treatment, especially when performing high-volume operations, are in old and senile age. This should be taken into account when managing them in the postoperative period. People of the discussed age have certain biological and physiological changes (gerontological) of all organs and systems, which determine the specifics
  20. Hygiene of a woman in a transitional menopause and in old age
    In the body of a woman throughout her life, complex processes continuously replacing each other occur, covering all spheres of her life. These processes are a reflection of age-related changes inherent in all living things. The years of childhood are replaced by an exciting youth, energetic maturity and, finally, rich life experience in a later period of life. The period of gradual fading
Medical portal "MedguideBook" © 2014-2019