Population pharmacokinetics of antibacterial agents in the older population: a literature review

ABSTRACT

Introduction

Older individuals face an elevated risk of developing bacterial infections. The optimal use of antibacterial agents in this population is challenging because of age-related physiological alterations, changes in pharmacokinetics (PK) and pharmacodynamics (PD), and the presence of multiple underlying diseases. Therefore, population pharmacokinetics (PPK) studies are of great importance for optimizing individual treatments and prompt identification of potential risk factors.

Area covered

Our search involved keywords such as ‘elderly,’ ‘old people,’ and ‘geriatric,’ combined with ‘population pharmacokinetics’ and ‘antibacterial agents.’ This comprehensive search yielded 11 categories encompassing 28 antibacterial drugs, including vancomycin, ceftriaxone, meropenem, and linezolid. Out of 127 studies identified, 26 (20.5%) were associated with vancomycin, 14 (11%) with meropenem, and 14 (11%) with piperacillin. Other antibacterial agents were administered less frequently.

Expert opinion

PPK studies are invaluable for elucidating the characteristics and relevant factors affecting the PK of antibacterial agents in the older population. Further research is warranted to develop and validate PPK models for antibacterial agents in this vulnerable population.

KEYWORDS:

• Antibacterial agents
• older individuals
• NONMEM
• population pharmacokinetics
• individualized treatment

Article highlights

• Older people need optimal regimens when administering various antibacterial agents.

• Population pharmacokinetic studies, though essential, are rare in the older population.

• This review presents the currently available PPK studies of antibacterial agents within this vulnerable population.

• Renal function plays a significant role in drug disposition in the elderly.

• Despite developing population pharmacokinetics models in older, more attention is required in its clinical application.

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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17512433.2023.2295009.

Additional information

Funding

This study is supported by National Key R&D Program of China [2020YFC2008303, 2020YFC2008306], Innovation and Development Joint Fund of Natural Science Foundation of Shandong Province [ZR2022LSW007], the Distinguished Expert of Taishan Scholars Shandong Province Project [tstp20230660], Distinguished Young and Middle-aged Scholar of Shandong University.