Safety and Tolerability of Antimicrobial Agents in the Older Patient.
Luca SoraciAntonio CherubiniLuca PaolettiGianfranco FilippelliFilippo LucianiPasqualina LaganàMaria Elsa GambuzzaElvira FilicettiAndrea CorsonelloFabrizia LattanzioPublished in: Drugs & aging (2023)
Older patients are at high risk of infections, which often present atypically and are associated with high morbidity and mortality. Antimicrobial treatment in older individuals with infectious diseases represents a clinical challenge, causing an increasing burden on worldwide healthcare systems; immunosenescence and the coexistence of multiple comorbidities determine complex polypharmacy regimens with an increase in drug-drug interactions and spread of multidrug-resistance infections. Aging-induced pharmacokinetic and pharmacodynamic changes can additionally increase the risk of inappropriate drug dosing, with underexposure that is associated with antimicrobial resistance and overexposure that may lead to adverse effects and poor adherence because of low tolerability. These issues need to be considered when starting antimicrobial prescriptions. National and international efforts have been made towards the implementation of antimicrobial stewardship (AMS) interventions to help clinicians improve the appropriateness and safety of antimicrobial prescriptions in both acute and long-term care settings. AMS programs were shown to decrease consumption of antimicrobials and to improve safety in hospitalized patients and older nursing home residents. With the abundance of antimicrobial prescriptions and the recent emergence of multidrug resistant pathogens, an in-depth review of antimicrobial prescriptions in geriatric clinical practice is needed. This review will discuss the special considerations for older individuals needing antimicrobials, including risk factors that shape risk profiles in geriatric populations as well as an evidence-based description of antimicrobial-induced adverse events in this patient population. It will highlight agents of concern for this age group and discuss interventions to mitigate the effects of inappropriate antimicrobial prescribing.
Keyphrases
- staphylococcus aureus
- physical activity
- healthcare
- antimicrobial resistance
- risk factors
- multidrug resistant
- infectious diseases
- primary care
- drug induced
- quality improvement
- clinical practice
- metabolic syndrome
- public health
- case report
- middle aged
- emergency department
- gram negative
- intensive care unit
- escherichia coli
- open label
- palliative care
- diabetic rats
- insulin resistance
- optical coherence tomography
- randomized controlled trial
- acinetobacter baumannii
- pseudomonas aeruginosa
- cystic fibrosis
- oxidative stress
- extracorporeal membrane oxygenation
- health information
- skeletal muscle