Risks associated with the use of antimicrobials in elderly
Keywords:
Antibiotics, Older people, Community infections, Adverse drug reactionsAbstract
Aim: Describe the most important physiological changes associated with aging, the characteristics of infections in these patients and the most common side effects and severe interactions with antimicrobials in older people.
Material and methods: We conducted a literature review on the risks associated with the use of antibiotics in the elderly. The information was based on the update of the scientific evidence and information from the drug Sheets. The search was limited to the past 11 years, selected papers published in English, Spanish or French. We performed an electronic search of secondary sources (systematic reviews) and a manual search “ad hoc” basis of the literature retrieved, primary studies, reports of drug evaluation agencies, clinical practice guidelines and documents of Scientific Societies. Information sources: Pubmed, Embase, Iowa Drug Information Service (IDIS), WinSPIRS 5.00, Up to Date, The Cochrane Library®.
Results: We identified 321 results, after eliminating those who did not meet inclusion criteria 52 papers in addition to the technical specifications of all mentioned antibiotics were included in the literature review.
Conclusion: Older patients can acquire infections more frequently multi-resistant pathogens and suffer more serious complications of infections. The antibiotics is a group of drugs sensitive to the physiological changes induced by aging, which may influence the response to these and often requires dosage modifications to avoid poisoning and / or therapeutic failures. This paper provides information on these physiological changes and risks of antibiotics in the elderly, aspects necessary to choose a proper treatment.
Downloads
References
Fernández Urrusuno R, Serrano Martino C, Corral Baena S, et al. Guía de Terapéutica Antimicrobiana del Área Aljarafe 2ª edición. Sevilla: Distrito Sanitario Aljarafe y Hospital San Juan de Dios del Aljarafe, 2012. Disponible en: http://www.juntadeandalucia.es/servicioandaluzdesalud/
guiaterapeuticaaljarafe/guiaTerapeuticaAljarafe/.
Hahn KL. The top 10 drug errors and how to prevent them. Em
Pharm Assoc Annual Meeting. 2007. Disponible en: http://www.medscape.com/viewarticle/556487?src=mp.
Rodríguez-Julbe M, Ramírez-Ronda C, Arroyo E, Maldonado G, Saavedra S, Meléndez B, González G, Figueroa J. Antibiotics in older adults. PR Health Sci J 2004; 23:25-33.
Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. An undate. Arch Intern Med 1997;157:1531-6.
The American Geriatrics Society. American Geriatrics Society update Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012;60:616-31.
Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: Results of a US consensus panel of experts. Arch Intern Med 2003;163:2716-24.
Lund BC, Steinman MA, Chrischilles EA, Kaboli PJ. Beers criteria as a proxy for inappropriate prescribing of other medications among older aldults. Disponible en: thhp://www.medscape.com/viewarticle/752613.
Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP
(Screening Tool of Older Person’s Prescriptions) and START
(Screening Tool to Alert doctors to Right Treatment). Consensus
validation. Int J Clin Pharmacol Ther 2008;46:72-86.
Delgado Silveira E, Muñoz García M, Montero Errasquin B, Sánchez Castellano C, Gallagher PF, Cruz-Jentoft AJ. Prescripción inapropiada de medicamentos en pacientes mayores: los criterios STOPP/START. Rev Esp Geriatr Gerontol 2009;44:273-9.
Wenger NS, Roth CP, Shekelle P and ACOVE investigators.
Introduction to the assessing care of vulnerable elders-3 quality
indicator measurement set. J Am Geriatr Soc 2007;55:S247-52.
Hanlon JT, Schmader KE, Smasa GP, Weiberger M, Utrech KM, Lewis IK et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol 1992;45:1045-51.
Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the Priscus list. Dtsch Arztebl Int 2010;107:543-51.
Noreddin AM, Haynes V. Use of pharmacodynamic principles to optimise dosage regimens for antibacterial agents in the elderly. Drugs Aging 2007;24:275-92.
Fichas técnicas de los medicamentos. Centro de Información online de Medicamentos. Agencia Española de Medicamentos y Productos Sanitarios. Disponible en: http://www.aemps.gob.es/cima/fichasTecnicas.do?metodo=detalleForm.
Garlington W, Schmader KE, Sokol HN. Evaluation of infection in the older adult. UpToDate 2011. Disponible en: http://www.uptodate.com/.
Azar A, Balas ZK. Inmune function in older adults. UpToDate 2011. Disponible en: http://www.uptodate.com/.
Martin Alcalde E, Molina Alcántara MC, Espinosa Gimeno E, Yela Gonzalo G. La farmacoterapia en el paciente anciano. Boletín
Farmaco-terapéutico Castilla La Mancha 2008, vol IX, nº 3.
Faulkner C, Cox HL, Williamson JC. Unique aspects of antimicrobial
use in older adults. Clin Infect Dis 2005;40:997-1004.
Strausbaugh LJ. Emerging health care-associated infections in the geriatric population. Emerg Infect Dis 2001;7:268-71.
Stalam M, Kaye D. Antibiotic agents in the elderly. Infectious
disease clinics of North America 2004;18:533-49.
Noreddin AM, El-Khatib WF, Haynes V. Optimal dosing design for antibiotic therapy in the elderly: a pharmacokinetic and pharmacodynamic perspective. Rec Pat Antiinfect Drug Disc 2008;3:45-52.
Herring AR, Williamson JC. Principles of antimicrobial use in older adults. Clin Geriatr Med 2007; 23:481-97.
Mouton CP, Bazaldua OV, Pierce B, Espino DV. Common infections in older adults. Am Fam Physician 2001;63:257.
McCue JD. Antibiotic use in the elderly: issues and nonissues. Clin Infect Dis1999;28:750-2.
Htwe TH, Mushtaq A, Robinson SB, Rosher RB, Khardori N. Infection in the Elderly. Infect Dis Clin N Ame 2007;21:711-43.
Chelsey L. Richard Jr. J. Infection control in long-term Care facilities. Am Med Dir Assoc 2007; S18-S25.
Fernández Gómez Busto. Rev Esp Geriatr Gerontol. 2007;42(Supl 1):39-50.
Lindsay E. Nicolle. Resistant pathogens in urinary tract infections. JAG 2002;50:S230-235.
Judith A. O´Donnell, Hofmann MT. Urinary tract infections. How to manage nursing home patients with or without chronic catheterization. Geriatrics. 2002. 57:45-58.
Montañés-Pauls B, Sáez-Lleó C, Martínez-Romero G. Ajuste de dosificación de medicamentos en pacientes ancianos institucionalizados. Farmacia Hospitalaria 2009;33:43-7.
Loeb M, Bentley DW, Bradley S, Crossley K, Garibaldi R, Gantz N, McGeer A, Muder RR, Mylotte J, Nicolle LE et al. Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: results of a consensus conference. Infect Control Hosp Epidemiol 2001;22:120-4.
High KP et al. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities 2008 (update by the Infectious Diseases Society of America). Clin Infect Dis 2009;48:149-71.
Ernst ME. Effectively treating common infections in residents
of long-term facilities. Pharmacotherapy 1999;19:1026-35.
Garibaldi RA. Residential care and the elderly: the burden of
infection. J Hospital Infection 1999; 43:9-18.
Kaltenbach G, Heitz D. Antibiotic-associated diarrhea in the elderly. Rev Med Interne. 2004. 25:46-53.
Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse events in older Americans. N Engl J Med 2011;365:2002-12.
Iannini PB. The safety profile of moxifloxacin and other fluorquinolones in special patient populations. Curr Med Res Opin 2007;23:1403-13.
Stahlmann R, Lode H. Safety considerations of fluorquinolones 38. in the elderly: an update. Drugs Aging 2010: 27:193-209.
Melhus A. Fluorquinolones and tendón disorders. Expert 39. Opin Drug Saf 2005;4:299-309.
Liu HH. Safety profile on the fluorquinolones: focus on 40. levofloxacin. Drug Saf 2010;33:353-69.
Bellon A, Perez-Garcia G, Coverdale JH, Chacko RX. Seizures 41. associated with levofloxacin: case presentation and literatura review. Eur J Clin Pharmacol 2009;65:959-62.
Owens RC, Ambrose PG. Antimicrobial safety: focus on 42. fluoroquinolones. Clin Infect Dis. 2005:41 Suppl 2:S144-57.
Fernández Espínola S, Suárez Alemán C, Vela Márquez C, 43. Bellosta Ymbert JM. Guía de uso adecuado de medicamentos en ancianos institucionalizados. Málaga: Distrito Sanitario Málaga, 2006.
Guía farmacoterapéutica de residencias para mayores. 44. Comisión de Farmacia y Terapéutica de Centros Geriátricos. Consejería de Salud y Consumo. Gobierno Islas Baleares 2007. Disponible en: http://www.elcomprimido.com/PDF/GFT_sociosanitarios.pdf.
Guía farmacogeriátrica. Dirección General de Farmacia y 45. Productos Sanitarios, Consejería de Sanidad y Consumo, Comunidad de Madrid. 2004. Disponible en: http://www.madrid.org/cs/Satellite?c=CM_Publicaciones_FA&cid=1114187449931&language=es&pagename=ComunidadMadrid%2FEstructura.
Vyas H, Krishnaswamy G. Images in clinical medicine. 46. Quinolone-associated rupture of the Achilles’ tendon. N Engl J Med. 2007;357:2067.
Chow KM, Szeto CC, Hui AC, Wong TY, Li PK. Retrospective 47. review of neurotoxicity induced by cefepime and ceftazidime. Pharmacotherapy 2003;23:369-73.
Medicamentos e intevalo QT. Boletín Terapéutico Andaluz. 48. 2003, vol 19, nº6.
Baciewicz AM, Sokos DR, Cowan RI. Aminoglycoside-49. associated nephrotoxicity in the elderly. Ann Pharmacother. 2003;37:182-6.
Lucena MI, Andrade RJ, Fernández MC, et al for the Spanish 50. Group for the Study of Drug-Induced Liver Disease (Grupo de Estudio para las Hepatopatías Asociadas a Medicamentos (GEHAM)). Determinants of the clinical expression of amoxicillin-clavulanate hepatotoxicity: a prospective series from Spain. Hepatology. 2006.44:850-6.
Van Bambeke F, Tulkens PM. Macrolides: pharmacokinetics 51. and pharmacodynamics. Int J Antimicrob Agents. 2001;18; Suppl 1:S17-23.
Interacciones de los fármacos más consumidos. Información 52. terapéutica del Sistema Nacional de Salud 2004, vol 28, nº 1.
Downloads
Published
How to Cite
Issue
Section
License
The articles, which are published in this journal, are subject to the following terms in relation to the rights of patrimonial or exploitation:
- The authors will keep their copyright and guarantee to the journal the right of first publication of their work, which will be distributed with a Creative Commons BY-NC-SA 4.0 license that allows third parties to reuse the work whenever its author, quote the original source and do not make commercial use of it.
b. The authors may adopt other non-exclusive licensing agreements for the distribution of the published version of the work (e.g., deposit it in an institutional telematic file or publish it in a monographic volume) provided that the original source of its publication is indicated.
c. Authors are allowed and advised to disseminate their work through the Internet (e.g. in institutional repositories or on their website) before and during the submission process, which can produce interesting exchanges and increase citations of the published work. (See The effect of open access).