Pharmacotherapy options and drug development in managing periprosthetic joint infections in the elderly

ABSTRACT

Introduction: Prosthetic joint infections are an increasingly important problem among patients undergoing arthroplasty procedures, and are associated with significant morbidity, reduced quality of life, substantial healthcare costs, and even mortality. Arthroplasties are performed with increasing frequency in elderly patients, who present specific problems.

Areas covered: Surgical therapy is clearly influenced by the clinical status of the patient, which in some case can contraindicate surgery. Antibiotic selection is also affected by comorbidities and underlying diseases, which in some cases reduce therapeutic options. The authors review this together with the changes in pharmacokinetics and pharmacodynamics in the elderly population and the prospects for future research on prevention and treatment.

Expert opinion: The management of PJI in the elderly makes multidisciplinary teams even more mandatory than in other patients, because the complexity of these patients. A frequent scenario is that in which surgery is contraindicated with long-term suppressive treatment as the only available option. Treating physicians must consider the presence of multiple comorbidities, interactions with other treatments and secondary effects when choosing antibiotic treatment. An in-depth knowledge of the alterations in pharmacokinetics and pharmacodynamics in elderly patients is key for a proper treatment selection.

KEYWORDS:

• Treatment
• elderly
• prosthetic joint infection
• pharmacotherapy
• antibiotic

Article highlights

• Prosthetic joint infections are expected to increase in elderly people because of the rise in the number of patients that undergo arthroplasty procedures.

• This increase will be also influenced by the growing number of comorbidities and risk factors in this age group.

• The selection of the surgical procedure must be performed considering patients’ frailty

• Antibiotic selection must take into account not only antimicrobial susceptibility, but also interactions with other treatments and potential adverse effects in elderly people.

• Pharmacology of antibiotics among these patients is affected by the status of the different organs involved in metabolism, as well as the comorbidity conditions of the patients.

• Future research aims to develop an ‘intelligent’ implant that detects and treats infection before clinical symptoms appear.

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Declaration of interest

J Esteban has received travel grants from Pfizer Inc, Biomérieux, Angelini, and Labroatorios Leti. The authors have no other 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 apart from those disclosed.

Reviewer disclosures

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

Additional information

Funding

This manuscript has not been funded.