RATIONAL APPROACH TO THE ANTIBIOTIC-TREATMENT OF PNEUMONIA IN THE ELDERLY

The incidence of pneumonia is highest among the aged compared with oth er adult populations, and causes significant morbidity and mortality a mong this group. Most episodes of pneumonia are caused by aspiration o f oropharyngeal flora into the lungs and failure of lung defence mecha nisms to eliminate the aspirated bacteria. Studies in elderly patients have shown a high rate of oropharyngeal carriage of Gram-negative bac illi and polymicrobial/mixed flora pneumonias, especially in debilitat ed elderly patients in nursing homes or hospitals. This information is helpful to practitioners in prescribing empirical antibiotic therapy for elderly patients with pneumonia. Because of the many additional co ncerns which must be considered in the rational selection of an antibi otic regimen. e.g. route of administration, compliance, drug pharmacok inetics and pharmacodynamics, drug toxicity, and drug-disease interact ions, it is also helpful for practitioners to become familiar with a s mall number of the large group of available antibiotics. Based on thes e considerations and the presumed bacteriology of pneumonia in the eld erly in the 3 clinical settings (community, nursing home and hospital) , a limited number of antibiotics are recommended for empirical antibi otic regimens for elderly patients with pneumonia. In particular, beta -lactamase inhibitors and cotrimoxazole (trimethoprim-sulfamethoxazole ) are recommended, with ciprofloxacin its an alternative agent. There is a limited role for third-generation cephalosporins and extended-spe ctrum penicillins. Aminoglycosides are only recommended for patients w ith pneumonia in the intensive care unit on mechanical ventilation. Mo notherapy (single agent) should be used whenever possible.