Antibiotic Therapy for Geriatric Patients

766 Pages·2005·11.18 MB·English

by  Yoshikawa

Antibiotic Therapy
for Geriatric Patients
DDKK33007799__FFMM..iinndddd 11 88//1100//0055 77::5566::0011 AAMM
PPrroocceessss CCyyaannPPrroocceessss MMaaggeennttaaPPrroocceessss YYeelllloowwPPrroocceessss BBllaacckk

Antibiotic Therapy
for Geriatric Patients
Edited by
THOMAS T. YOSHIKAWA
Charles R. Drew University of Medicine and Science
Martin Luther King, Jr.–Charles R. Drew Medical Center
Los Angeles, California, U.S.A.
SHOBITA RAJAGOPALAN
Charles R. Drew University of Medicine and Science
Martin Luther King, Jr.–Charles R. Drew Medical Center
Los Angeles, California, U.S.A.
DDKK33007799__FFMM..iinndddd 22 88//1100//0055 77::5566::0022 AAMM
PPrroocceessss CCyyaannPPrroocceessss MMaaggeennttaaPPrroocceessss YYeelllloowwPPrroocceessss BBllaacckk
DK3079_Discl.fm Page 1 Tuesday, August 9, 2005 4:17 PM
Published in 2006 by
Taylor & Francis Group
270 Madison Avenue
New York, NY 10016
© 2006 by Taylor & Francis Group, LLC
No claim to original U.S. Government works
Printed in the United States of America on acid-free paper
10 9 8 7 6 5 4 3 2 1
International Standard Book Number-10: 0-8247-2783-5 (Hardcover)
International Standard Book Number-13: 978-0-8247-2783-3 (Hardcover)
This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with
permission, and sources are indicated. A wide variety of references are listed. Reasonable efforts have been made to publish
reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials
or for the consequences of their use.
No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or
other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information
storage or retrieval system, without written permission from the publishers.
For permission to photocopy or use material electronically from this work, please access www.copyright.com
(http://www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC) 222 Rosewood Drive, Danvers, MA
01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For
organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for
identification and explanation without intent to infringe.
Library of Congress Cataloging-in-Publication Data
Catalog record is available from the Library of Congress
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
Taylor & Francis Group
is the Academic Division of T&F Informa plc.
Preface
Infectionsaremajorcausesofmorbidityandmortalityinolderadults.Thediagnosis
of infections in the elderly patient may be difficult and often delayed. Thus, life-
savingtreatmentsmaybeomittedorinitiatedlateinthecourseoftheillness,resulting
inpooroutcomes.Diagnosticprocedurestofacilitateamorespecificmicrobiological
diagnosis are often not performed in elderly patients because of potentially greater
complication rates, difficulty in obtaining cooperation from cognitively impaired or
physically disabled patients, or failure to understand the importance of elucidating
aspecificmicrobiologicaldiagnosis.Consequently,empiricalantibiotictherapywith
broad-spectrumdrugsisfrequentlyprescribed.Notsurprisingly,thereisanincreasing
prevalenceofantibiotic-resistantpathogens,especiallyintheinstitutionalsettingand
amongfrail,debilitatedelderlypersons.Tocombattheseresistantorganisms,newer
and more potent antibiotics are being constantly manufactured. The number and
types of newer antimicrobial agents can become overwhelming and impossible to
comprehendfortheclinicianwhocaresforolderpatients.Moreover,newandemer-
ginginfectiousagents(e.g.,WestNilevirus,severeacuterespiratorysyndrome)often
attack the elderly population with greater frequency and/or severity. A current
knowledgeofeffectivetreatments(ifany)forthesepathogensisimperative.
Most clinicians caring for a large number of geriatric patients have little time
for in-depth reading on topics that are relevant to their day-to-day care of patients.
Thus, any reference source should be clinically relevant, easy to read, accurate,
current, and relatively inexpensive. It should also provide quick access to the essen-
tial or core information about a clinical issue or topic.
Antibiotic Therapy for Geriatric Patients is such a book. It is written by the
foremostauthoritiesintheareaofinfectionandaging.Thebookisdividedintofive
major sections: I. Important Principles and Concepts of Infections and Aging;
II.SpecificImportantAntibiotics;III.MajorClinicalInfections;IV.SelectedPatho-
gens; and V. Infections in Long-Term Care. Section I summarizes many of the
unique and important aspects and concepts of infectious diseases in older adults,
such as epidemiology, clinical manifestations, altered host resistance, and pharma-
cology. Section II provides all of the key and necessary information regarding the
most important and clinically relevant antibiotics prescribed for elderly patients.
The information is organized in a consistent, concise, and clear manner so that
the reader can quickly access and review the information. Pharmacokinetic and
pharmacodynamicinformation,indications,dosage,precautions,andadverseeffects
relevanttoolderpatientsarepresented.SectionIIIdescribesinaconcisemannerthe
diagnosis and treatment of major infections in the elderly with emphasis on key
iii
iv Preface
features that are specific or relevant to elderly patients. Section IV discusses select
and common pathogens associated with infections encountered in aging adults.
SectionVisdevotedtothespecialproblemsofinfectionsinlong-termcarefacilities
suchasanursinghome.Referencesareprovidedwitheachchapter.Eachchapteris
summarized with ‘‘key points’’ that highlight important and practicalaspects of the
specific topic.
Antibiotic Therapy for Geriatric Patients is an ideal and authoritative resource
for practicing clinicians including geriatricians, infectious disease specialists, geron-
tologists, primary care physicians, internists, pharmacists, nursing home directors
and administrators, infection control practitioners, and upper-level undergraduate
and graduate students in these disciplines.
Thomas T. Yoshikawa, M.D.
Shobita Rajagopalan, M.D.
Contents
Preface . . . . iii
Contributors . . . . xix
SECTION I: IMPORTANT PRINCIPLES AND CONCEPTS
OF AGING
1. Epidemiology and Unique Aspects of Infections . . . . . . . . . . . . . . . . 1
Deborah Moran and Thomas T. Yoshikawa
1. Introduction . . . . 1
2. Life Expectancy . . . . 2
3. The Epidemiologic Triangle . . . . 3
4. Unique Ethical Considerations . . . . 6
4. References . . . . 6
4. Suggested Reading . . . . 7
2. Clinical Manifestations of Infections . . . . . . . . . . . . . . . . . . . . . . . 9
Nancy Hanna and Thomas T. Yoshikawa
1. Introduction . . . . 9
2. Immunosenescence . . . . 10
3. History . . . . 10
4. Physical Examination . . . . 12
5. Diagnostic Procedures . . . . 13
4. References . . . . 16
4. Suggested Reading . . . . 17
3. Impact of Age and Chronic Illness-Related Immune Dysfunction
on Risk of Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Steven C. Castle, Asif Rafi, Koichi Uyemura, and Takashi Makinodan
1. Introduction . . . . 19
2. Immunosenescence . . . . 20
3. Impact of Chronic Illness on Infections Seen in the Older
4. Adult . . . . 21
4. Age-Related Changes of Immune Response . . . . 24
5. Summary of Age-Related Changes in Acquired Immunity . . . . 26
6. Interaction Between Innate and Acquired Immunity . . . . 27
v
vi Contents
7. Immune Potentiating Effects of Dietary Supplements and
4. Medications . . . . 30
8. Conclusion . . . . 32
4. References . . . . 33
4. Suggested Reading . . . . 35
4. Functional Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Ronan Factora and Robert M. Palmer
1. Introduction . . . . 37
2. Physical Functioning . . . . 40
3. Cognitive Function . . . . 44
4. Caregivers . . . . 47
5. Preventing Functional Decline . . . . 48
6. Summary . . . . 50
4. References . . . . 51
4. Suggested Reading . . . . 52
5. Assessment of Nutritional Status and Interventions
to Reduce Infection Risk in the Elderly . . . . . . . . . . . . . . . . . . . . 53
Kevin P. High
1. The Epidemiology of Malnutrition in Older Adults
4. and Its Clinical Relevance . . . . 54
2. Nutritional Prevention of Specific Infectious Syndromes
4. in Older Adults . . . . 63
3. Conclusions and Recommendations . . . . 64
4. References . . . . 65
4. Suggested Reading . . . . 66
6. Pharmacology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Jay P. Rho and Jiwon Kim
1. Introduction . . . . 67
2. Pharmacokinetics . . . . 68
3. Pharmacodynamics . . . . 72
4. Antimicrobial Combinations . . . . 72
4. References . . . . 74
4. Suggested Reading . . . . 76
SECTION II: SPECIFIC IMPORTANT ANTIBIOTICS
7. Penicillins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Sanjeet Dadwal
1. Introduction . . . . 77
2. Chemistry and Mechanism of Action . . . . 78
3. Antimicrobial Spectrum . . . . 79
4. Clinical Pharmacology . . . . 80
5. Clinical Indications . . . . 85
6. Administration of Drug . . . . 86
Contents vii
7. Drug Monitoring and Adverse Effects . . . . 86
4. References . . . . 88
4. Suggested Reading . . . . 89
8. Cephalosporins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Jack D. McCue
1. Chemistry and Mechanism of Action . . . . 92
2. Antimicrobial Spectrum and Classification . . . . 93
3. Clinical Pharmacology . . . . 94
4. Antimicrobial Spectrum . . . . 96
5. Clinical Indications . . . . 98
6. Administration of Drug . . . . 101
7. Adverse Effects . . . . 101
4. References . . . . 104
4. Suggested Reading . . . . 105
9. The Carbapenems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
David R. P. Guay
1. Introduction . . . . 107
2. Chemistry and Mechanism of Action . . . . 108
3. Antimicrobial Spectrum . . . . 108
4. Clinical Pharmacology . . . . 110
5. Clinical Indications . . . . 114
6. Dosing and Administration . . . . 116
7. Adverse Events . . . . 116
4. References . . . . 126
4. Suggested Reading . . . . 127
10. Monobactams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Jay P. Rho
1. Introduction . . . . 129
2. Chemistry . . . . 130
3. Mechanism of Action . . . . 130
4. Antimicrobial Spectrum . . . . 131
5. Clinical Pharmacology . . . . 131
6. Clinical Indications . . . . 132
7. Administration of Drug . . . . 136
8. Drug Monitoring and Adverse Effects . . . . 136
4. References . . . . 137
4. Suggested Reading . . . . 139
11. b-Lactam/b-Lactamase Inhibitors . . . . . . . . . . . . . . . . . . . . . . . 141
Robert A. Bonomo
1. b-Lactam Antibiotics, b-Lactamases, and b-Lactamase
4. Inhibition . . . . 141
2. Chemistry and Mechanism of Action . . . . 144