Pharmacotherapy for community-acquired pneumonia in the elderly

ABSTRACT

Introduction: Community-acquired pneumonia (CAP) is an increasing problem in the elderly that is associated with elevated morbidity and mortality. Given the expected increased life expectancy, this problem is only likely to worsen, so it has been considered that treatment effects must be examined separately in elderly adults with CAP.

Areas covered: In this narrative review, we give an update of the available data of antibiotics for elderly patients with CAP. Clinical features, drug pharmacokinetics and pharmacodynamics, adverse effects, and outcomes differ in CAP depending on patient age. Older age, for example, can affect the effect of specific antibiotic regimens on important CAP clinical outcomes. Current guidelines do not offer specific recommendations for the management of CAP in elderly patients.

Expert opinion: Most of our knowledge about the treatment of CAP in elderly patients has been gained from studies in young populations. However, elderly patients with CAP deserve special attention because there are several factors in this population that could influence their response to antibiotic regimens in CAP.

KEYWORDS:

• Antibiotic
• community-acquired pneumonia
• elderly
• treatment

Article highlights

• CAP in the elderly has become a major public health problem that is associated with elevated morbidity and mortality.

• The clinical features and etiology of CAP appear to differ between elderly and young adult patients.

• There has been underrepresentation of elderly adults in clinical trials of CAP.

• The aging process involves all body organs and alters the absorption, metabolism, excretion, and targets effects of antibiotics.

• Comorbidities and polypharmacy should be considered when prescribing antimicrobial therapy for older patients CAP.

• There is an urgent need for studies evaluating the pharmacodynamics and pharmacokinetics of antibiotics and specific antimicrobial regimens on important clinical outcomes in elderly patients.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This study was supported by Ministerio de Economía y Competitividad, Instituto de Salud Carlos III (grant 11/01106 and 14/00580) - co-financed by European Development Regional Fund ‘A way to achieve Europe’ ERDF, Spanish Network for the Research in Infectious Diseases (REIPI), and the Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Spain; and Universidad del Norte. The sponsors had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.