Antibiotic agents in the elderly

In the year 2000, for the first time in the United States, people older tha n 60 years outnumber children aged 14 years and younger. By the year 2050, the number of Americans older than 65 years of age will double to reach nea rly 80 million.(51) In spite of the many advances that have occurred in the prevention, diagnosis, and treatment of infectious diseases, infections st ill cause 30% of deaths in the elderly and are the most frequent cause of h ospitalization in this population. Managing infections in the elderly is a challenge. Diagnosis of infections can be problematic, because elderly patients frequently lack classic signs and symptoms of infection such as fever and leukocytosis. When infection oc curs, the elderly often present with unusual symptoms such as poor appetite , nausea, vomiting, and changes in mental status. Physical findings and lab oratory results are often difficult to interpret as many of the elderly hav e baseline pulmonary and urinary tract abnormalities (e.g., rales, bacteriu ria, pyuria). Therapy is problematic because of the increased potential for toxicity of antimicrobial agents in the elderly. The following sections discuss some of the important physiologic changes, d rug-drug interactions, compliance issues, and reasons for increased side ef fects that affect use of antimicrobial agents in the elderly. There is also a review of the most frequently encountered bacterial infections in the el derly and recommendations for therapy. Although less than 10% of the entire population older than the age of 65 ye ars resides in long-term care facilities (LTCF),(37) the challenges of mana ging infections in this population are great. Therefore, special comments a bout patients in LTCF are incorporated into the discussion of frequently en countered infections in the elderly.