Optimal Dosing Design for Antibiotic Therapy in the Elderly: A Pharmacokinetic and Pharmacodynamic Perspective

Ayman   M.   Noreddin; Walid      El-Khatib; Virginia      Haynes; Walid   F.   El-Khatib

Abstract

As our aged population increases, infections among elderly residing in long term care facilities will challenge our ability to maintain an effective battery of antibiotics. In this setting, we can predict infection by antibiotic resistant organisms in elderly patients with a history of previous antibiotic treatment and exposure to resistant organisms from multiple hospitalizations. The elderly often acquire infections in tandem with common disease states such as diabetes and heart disease. Polypharmacy increases risk of synergistic and antagonist reactions between pharmaceuticals. Elderly patients may be deficient in their ability to clear drugs from the body due to declining lung, kidney/bladder, gastrointestinal and circulatory efficiency. Accumulation of standard antibiotic doses in the body leads to heightened risk of achieving toxic drug levels and increases the chances of unfavorable interactions with other medications. Optimized dosing strategies must be designed specifically for this population using pharmacodynamic principles that honor the unique circumstances of the elderly. Rational and effective dosing strategies based on pharmacodynamic breakpoints and detailed understanding of the pharmacokinetics of antibiotics in the elderly further the goal of achieving complete eradication of an infection in a timely manner, prevent selection of drug resistant bacteria and minimize toxic effects in elderly patients. The present article includes information of patents for antibiotic therapy in the elderly

Keywords: Pharmacokinetics, pharmacodynamics, adverse drug reactions, elderly, aminoglycosides, β-Lactams, macrolides, glycopeptides, fluoroquinolones, PK/PD