Antimicrobial treatment of bacterial infections in frail elderly patients: the difficult balance between efficacy, safety and tolerability

Fifth Chinese National Consensus Report on the management ofHelicobacter pyloriinfection

“…A questionnaire survey showed that the majority of clinicians tended to be conservative when they considered H. pylori eradication in elderly patient . In general, elderly adults (age >70 years) have a low tolerance and compliance to H. pylori eradication therapy, and they have an increased risk of drug side effect . In contrast, the potential benefit of eradication of H. pylori for preventing gastric cancer in patients with nonatrophic gastritis or mild atrophic gastritis is decreased.…”

Grand challenge in antibiotic pharmacology: A major step toward tailored antimicrobial treatment in very complex clinical scenarios of infectious risk management

“…The optimisation or lack optimisation of antibiotic concentrations at the site of the infectious lesion may be a contributor to success or failure and the emergence of resistance (Pea and Viale, 2009;. On the other hand, it should also not be overlooked that overexposure may increase the toxicity risk in some patient settings, as it may occur particularly in the fragile elderly population (Pea, 2015).…”

“…The need to customize antimicrobial treatment may be especially relevant in frail elderly patients, in whom the right balance between efficacy, safety and tolerability could be very difficult to be addressed (Table 1) (Pea, 2015). Frailty is a condition essentially related to a decline in functional reserves and is considered an important risk factor for adverse effects among the elderly.…”

“…Frailty per se may affect antimicrobial exposure as it may be associated to various degrees of renal dysfunction. Additionally, the frequent need of polypharmacy or hyper-polypharmacy in frail elderly patients with multiple comorbidities may lead to major drug-drug interactions responsible for altered antimicrobial exposure (Pea, 2015;Pea, 2018). This may expose the frail elderly with severe infections to an increased risk of overexposure and toxicity when are treated with standard doses of antibiotics.…”

Antibiothérapie du sujet âgé : On peut toujours mieux faire

“…Il n'y a pas de données sur une toxicité dose-dépendante, mais le risque de toxicité intrinsèque est connu, avec troubles neurologiques, hypoglycémie, insuffi sances rénale et hépatocellulaire (Aspinall et al, 2009 ;Bird, Etminan, Brophy, Hartzema, & Delaney, 2013 ;Chou et al, 2013 ;Paterson, Mamdani, Manno, & Juurlink, 2012 ;Stahlmann & Lode, 2010 ). Il faut être vigilant quant aux interactions médicamenteuses, en cas de compétition au niveau du métabolisme enzymatique hépatique (inhibition des CYP3A4 et CYP1A2), en particulier avec les anticoagulants oraux, les benzodiazépines et les statines, étant donné le risque d'hémorragie, de somnolence ou de rhabdomyolyse du fait de surdosage ou lors de la prise de certains antidiabétique oraux (en particulier les sulfonylurées) avec potentialisation du risque d'hypoglycémie (Pea, 2015 ;Stahlmann & Lode, 2010 ).…”