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Antibiothérapie du sujet âgé : On peut toujours mieux faire

Published online by Cambridge University Press:  13 June 2016

Violaine Tolsma ,
Jacques Gaillat  and
Leonardo Pagani Open the ORCID record for Leonardo Pagani [Opens in a new window]
Violaine Tolsma
Affiliation:
Service de Maladies Infectieuses, Centre Hospitalier Annecy-Genevois (CHANGE), Annecy; France.
Jacques Gaillat
Affiliation:
Service de Maladies Infectieuses, Centre Hospitalier Annecy-Genevois (CHANGE), Annecy; France.
Leonardo Pagani*
Affiliation:
Programme de Bon Usage des Antimicrobiens, Centre Hospitalier Annecy-Genevois (CHANGE), Annecy; France. Service de Maladies Infectieuses, Hôpital Central de Bolzano, I-39100, Bolzano; Italie
*
*La correspondance et les demandes de tiré à part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Leonardo Pagani, M.D. Service de Maladies Infectieuses Hôpital Central de Bolzano Bolzano, Italie ([email protected])
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Abstract

Antimicrobials are among the most prescribed drugs and their prescription increases with age, due to frailty and accrued risk factors for acquiring infections. Antimicrobial prescription in elderly patients must not only account for the risk of toxicity due to drug overexposure, but also of treatment failure or promotion of antimicrobial resistance due to under-dosage. This paper reviews the main antimicrobial, pharmacokinetic and pharmacodynamic variations induced by aging, comorbidities and polypharmacy, and how to take them into account to optimize antimicrobial prescription in elders.

Résumé

Les antibiotiques figurent parmi les traitements les plus fréquemment utilisés et leur prescription augmente avec l’âge, du fait de la fragilité et d’autres facteurs qui augmentent le risque d’infection dans la population gériatrique. La prescription d’un traitement anti-infectieux chez le sujet âgé doit tenir compte du risque de toxicité liée au surdosage mais aussi de celui d’échec ou d’émergence de résistance en cas de sous-dosage. Cet article décrit les principales modifications des paramètres pharmacocinétiques et pharmacodynamiques induites par le vieillissement physiologique, les comorbidités ou la polymédication, et comment les prendre en compte pour optimiser la prescription des antibiotiques.

Keywords

antimicrobialspharmacokineticspharmacodynamicselderly patients (subjects)anti-infectieuxpharmacocinétiquepharmacodynamiesujets âgé
Type
Policy and Practice Notes / Notes sur les politiques et les pratiques
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 35 , Issue 3 , September 2016 , pp. 385 - 392
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Copyright
Copyright © Canadian Association on Gerontology 2016 

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