Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Drugs & Therapy Perspectives
Published in: Drugs & Therapy Perspectives 4/2024

28-04-2024 | Pharmacokinetics | Drug Reactions and Interactions

Adjust antimicrobial agent regimens in older patients to correct for changes in pharmacokinetics and to avoid adverse events

Author: Simon Fung

Published in: Drugs & Therapy Perspectives | Issue 4/2024

Login to get access

Abstract

Treating infections with antimicrobial agents in older patients can be challenging. Physiological changes associated with aging can alter the pharmacokinetics of antimicrobial agents; dose adjustments may be required to provide effective and safe treatment. Additionally, the choice of antimicrobial agent can be limited by comorbidities and the use of other medications in these patients. It is vital to tailor the choice of antimicrobial agent and the dose to the clinical profile of the patient.
Literature
1.
Schoevaerdts D, Sibille FX, Gavazzi G. Infections in the older population: what do we know? Aging Clin Exp Res. 2021;33(3):689–701.CrossRefPubMed
2.
3.
Budnitz DS, Lovegrove MC, Shehab N, et al. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365(21):2002–12.CrossRefPubMed
4.
Kaur U, Shubhra Chakrabarti S, Singh B, et al. A prospective observational pilot study of adverse drug reactions in patients admitted in the geriatric ward of a tertiary hospital in North India. Curr Pharmacogenom Pers Med. 2018;16(2):147–55.CrossRef
5.
Olivier P, Bertrand L, Tubery M, et al. Hospitalizations because of adverse drug reactions in elderly patients admitted through the emergency department: a prospective survey. Drugs Aging. 2009;26(6):475–82.CrossRefPubMed
6.
7.
Noreddin AM, Haynes V. Use of pharmacodynamic principles to optimise dosage regimens for antibacterial agents in the elderly. Drugs Aging. 2007;24(4):275–92.CrossRefPubMed
8.
Forbes GB, Reina JC. Adult lean body mass declines with age: some longitudinal observations. Metabolism. 1970;19(9):653–63.CrossRefPubMed
9.
Ulldemolins M, Roberts JA, Rello J, et al. The effects of hypoalbuminaemia on optimizing antibacterial dosing in critically ill patients. Clin Pharmacokinet. 2011;50(2):99–110.CrossRefPubMed
10.
Budingen FV, Gonzalez D, Tucker AN, et al. Relevance of liver failure for anti-infective agents: from pharmacokinetic alterations to dosage adjustments. Ther Adv Infect Dis. 2014;2(1):17–42.PubMedCentral
11.
Mallappallil M, Friedman EA, Delano BG, et al. Chronic kidney disease in the elderly: evaluation and management. Clin Pract (Lond). 2014;11(5):525–35.CrossRefPubMedPubMedCentral
12.
Bruck K, Stel VS, Gambaro G, et al. CKD prevalence varies across the European general population. J Am Soc Nephrol. 2016;27(7):2135–47.CrossRefPubMed
13.
Pereira JM, Paiva JA. Antimicrobial drug interactions in the critically ill patients. Curr Clin Pharmacol. 2013;8(1):25–38.PubMed
14.
Mazzei T. The difficulties of polytherapy: examples from antimicrobial chemotherapy. Intern Emerg Med. 2011;6(Suppl 1):103–9.CrossRefPubMed
15.
16.
Iwamoto M, Wenning LA, Nguyen BY, et al. Effects of omeprazole on plasma levels of raltegravir. Clin Infect Dis. 2009;48(4):489–92.CrossRefPubMed
17.
Weitschies W, Friedrich C, Wedemeyer RS, et al. Bioavailability of amoxicillin and clavulanic acid from extended release tablets depends on intragastric tablet deposition and gastric emptying. Eur J Pharm Biopharm. 2008;70(2):641–8.CrossRefPubMed
18.
Tremblay D, Dupront A, Ho C, et al. Pharmacokinetics of cefpodoxime in young and elderly volunteers after single doses. J Antimicrob Chemother. 1990;26(Suppl E):21–8.CrossRefPubMed
19.
Chutka DS, Evans JM, Fleming KC, et al. Symposium on geriatrics - part I: drug prescribing for elderly patients. Mayo Clin Proc. 1995;70(7):685–93.CrossRefPubMed
20.
Pea F, Viale P, Furlanut M. Antimicrobial therapy in critically ill patients: a review of pathophysiological conditions responsible for altered disposition and pharmacokinetic variability. Clin Pharmacokinet. 2005;44(10):1009–34.CrossRefPubMed
21.
Faulkner CM, Cox HL, Williamson JC. Unique aspects of antimicrobial use in older adults. Clin Infect Dis. 2005;40(7):997–1004.CrossRefPubMed
22.
Schmucker DL. Liver function and phase I drug metabolism in the elderly: a paradox. Drugs Aging. 2001;18(11):837–51.CrossRefPubMed
23.
24.
Trotman RL, Williamson JC, Shoemaker DM, et al. Antibiotic dosing in critically ill adult patients receiving continuous renal replacement therapy. Clin Infect Dis. 2005;41(8):1159–66.CrossRefPubMed
25.
Midao L, Giardini A, Menditto E, et al. Polypharmacy prevalence among older adults based on the survey of health, ageing and retirement in Europe. Arch Gerontol Geriatr. 2018;78:213–20.CrossRefPubMed
26.
Antoniou T, Gomes T, Juurlink DN, et al. Trimethoprim-sulfamethoxazole-induced hyperkalemia in patients receiving inhibitors of the renin-angiotensin system: a population-based study. Arch Intern Med. 2010;170(12):1045–9.CrossRefPubMed
27.
Baillargeon J, Holmes HM, Lin YL, et al. Concurrent use of warfarin and antibiotics and the risk of bleeding in older adults. Am J Med. 2012;125(2):183–9.CrossRefPubMedPubMedCentral
28.
Chang SH, Chou IJ, Yeh YH, et al. Association between use of non-vitamin K oral anticoagulants with and without concurrent medications and risk of major bleeding in nonvalvular atrial fibrillation. JAMA. 2017;318(13):1250–9.CrossRefPubMedPubMedCentral
29.
Lippi G, Favaloro EJ, Mattiuzzi C. Combined administration of antibiotics and direct oral anticoagulants: a renewed indication for laboratory monitoring? Semin Thromb Hemost. 2014;40(7):756–65.CrossRefPubMed
30.
Chinzowu T, Roy S, Nishtala PS. Risk of antimicrobial-associated organ injury among the older adults: a systematic review and meta-analysis. BMC Geriatr. 2021;21(1):617.CrossRefPubMedPubMedCentral
31.
Lucena MI, Sanabria J, García-Cortes M, et al. Drug-induced liver injury in older people. Lancet Gastroenterol Hepatol. 2020;5(9):862–74.CrossRefPubMed
32.
Schliamser SE, Cars O, Norrby SR. Neurotoxicity of beta-lactam antibiotics: predisposing factors and pathogenesis. J Antimicrob Chemother. 1991;27(4):405–25.CrossRefPubMed
33.
34.
Ramappa V, Aithal GP. Hepatotoxicity related to anti-tuberculosis drugs: mechanisms and management. J Clin Exp Hepatol. 2013;3(1):37–49.CrossRefPubMed
35.
Holmberg L, Boman G, Bottiger LE, et al. Adverse reactions to nitrofurantoin. Analysis of 921 reports. Am J Med. 1980;69(5):733–8.CrossRefPubMed
36.
Aspinall SL, Good CB, Jiang R, et al. Severe dysglycemia with the fluoroquinolones: a class effect? Clin Infect Dis. 2009;49(3):402–8.CrossRefPubMed
Metadata
Title
Adjust antimicrobial agent regimens in older patients to correct for changes in pharmacokinetics and to avoid adverse events
Author
Simon Fung
Publication date
28-04-2024
Publisher
Springer International Publishing
Published in
Drugs & Therapy Perspectives / Issue 4/2024
Print ISSN: 1172-0360
Electronic ISSN: 1179-1977
DOI
https://doi.org/10.1007/s40267-024-01065-w

Other articles of this Issue 4/2024

Drugs & Therapy Perspectives 4/2024 Go to the issue

Original Research Article

Increasing patient safety due to an implemented ward pharmacist in an interprofessional cancer care team evaluated in a prospective, controlled intervention study

Adis Summary of Research

Adis Summary of Research: Extended‑Release Viloxazine Compared with Atomoxetine for Attention Deficit Hyperactivity Disorder

Drug Reactions and Interactions

Determine and remove the drug trigger, usually antibiotics, that causes acute generalised exanthematous pustulosis

Correction

Correction to: Buprenorphine extended-release injection (Brixadi®) in the management of opioid use disorder: a profile of its use in the USA

Original Research Article

Assessment of rational antibiotic use among children being treated in primary care facilities in Punjab, Pakistan: findings and implications