Elderly antimicrobials

Host factors can help to ensure selection of the most appropriate antimicrobial agent. Age is an important factor in antimicrobial selection. With regard to dose and interval, renal and hepatic function varies with age. Populations with diminished renal function include neonates and the elderly. Hepatic function in the neonate is not fully developed, and drugs that are metabolized or eliminated by this route may produce adverse effects. For example, sulfonamides and ceftriaxone may compete with bilirubin for binding sites and may result in hyperbilirubinemia and kernicterus. Gastric acidity also depends on... 

Jensen, S.E., Elder, K.J., Aidoo, K.A. and Paradkar, A.S., (2000) Enzymes catalyzing the early steps of clavulanic acid biosynthesis are encoded by two sets of paralogous genes in Streptomyces clavuligerus. Antimicrobial Agents and Chemotherapy, 44, 720-726. 

Antimicrobials are indicated in the infirm, those who are immunocompromised, children in daycare centers, the elderly, malnourished children, and healthcare workers. Antimicrobials may shorten the period of fecal shedding and attenuate the clinical illness. 

Parsley possesses carminative, antispasmodic, diuretic, emmenagogue, expectorant, antirheumatic, and antimicrobial properties. Traditionally, it is used for flatulent dyspepsia, colic, cystitis, dysuria, bronchitic cough in elderly people, dysmenorrhea, functional amenorrhea, myalgia, and specifically for flatulent dyspepsia with intestinal colic. 

Correct answer = D. Elevated blood pressure would not be expected to markedly influence the type of antimicrobial treatment employed. Anticancer drugs often suppress the immune function, and these patients require additional antibiotics to eradicate infections. Impaired renal function may lead to accumulation of toxic levels of antimicrobial drugs. Renal and hepatic function are often decreased among the elderly. Impaired liver function may lead to the accumulation of toxic levels of antimicrobial drugs. 

This may be found by routine urine testing of pregnant women or patients with known structural abnormalities of the urinary tract. Such infection may explain micturition frequency or incontinence in the elderly. Appropriate antimicrobial therapy should be given, chosen on the basis of susceptibility tests, and normally for 7-10 days. Amoxicillin or a cephalosporin is preferred in pregnancy, although nitrofurantoin may be used if imminent delivery is not likely (see below). 

Leukocytosis is a normal host defense to infection and is an important adjunct to antimicrobial therapy. Unfortunately, bacterial infection is a common complication of neutropenia from cancer chemotherapy. These patients are incapable of increasing their WBCs in response to infection. In fact, susceptibility to infection in these patients is highly dependent on their WBC status. Patients with neutrophil counts of less than 500 cells/mm are at high risk for the development of bacterial or fungal infections. The absence of leukocytosis also occurs in the elderly and in severe cases of sepsis. ... 

Owing to the self-limiting nature of the illness and rapid development of antimicrobial resistance on completion of therapy, antibiotic treatment is reserved for the elderly and infirmed, those who are immunocompromised, children in day-care centers, malnourished children, and health care workers. Antibiotics shorten... 

Several smdies in hospitalized elderly subjects, however, have not found antimicrobial therapy to be efflcacious. A number of questions remain unanswered, e.g., the effect of eradication of bacteri-... 

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