Abstract
Lower respiratory tract infections (LRTIs) refer to the inflammation of the trachea, bronchi, bronchioles, and lung tissue. Old people have an increased risk of developing LRTIs compared to young adults. The prevalence of LRTIs in the elderly population is not only related to underlying diseases and aging itself, but also to a variety of clinical issues, such as history of hospitalization, previous antibacterial therapy, mechanical ventilation, antibiotic resistance. These factors mentioned above have led to an increase in the prevalence and mortality of LRTIs in the elderly, and new medical strategies targeting LRTIs in this population are urgently needed. After a systematic review of the current randomized controlled trials and related studies, we recommend novel pharmacotherapies that demonstrate advantages for the management of LRTIs in people over the age of 65. We also briefly reviewed current medications for respiratory communicable diseases in the elderly. Various sources of information were used to ensure all relevant studies were included. We searched Pubmed, MEDLINE (OvidSP), EMBASE (OvidSP), and ClinicalTrials.gov. Strengths and limitations of these drugs were evaluated based on whether they have novelty of mechanism, favorable pharmacokinetic/pharmacodynamic profiles, avoidance of interactions and intolerance, simplicity of dosing, and their ability to cope with challenges which was mainly evaluated by the primary and secondary endpoints. The purpose of this review is to recommend the most promising antibiotics for treatment of LRTIs in the elderly (both in hospital and in the outpatient setting) based on the existing results of clinical studies with the novel antibiotics, and to briefly review current medications for respiratory communicable diseases in the elderly, aiming to a better management of LRTIs in clinical practice.
Highlights
The elderly may suffer from inappropriate medication due to decreased vision, memory loss, impaired cognition, low compliance, and unsupervised care
After systematically retrieving the following sources including Pubmed, MEDLINE (OvidSP), and EMBASE (OvidSP) from October 2010 to July 2018, we have collected 87 clinical trials and manual screened out 58 trials, and elaborated the advantages and limitations of the application of novel antibiotics in clinical practice based on these trials
All the random control trials (RCTs) included in our study share the following characteristics: trials included patients over 65 years of age who met at least three symptoms: cough, purulent sputum, dyspnea or pleurisy; if they had at least two abnormal vital signs, had at least one laboratory test result or clinical sign associated with Lower respiratory tract infections (LRTIs), and had radiologically confirmed pneumonia, these trials were classified as the risk classes in Pneumonia Severity Index (PSI), ranging from II to V
Summary
The elderly may suffer from inappropriate medication due to decreased vision, memory loss, impaired cognition, low compliance, and unsupervised care. Infections usually manifest as atypical symptoms such as lethargy, loss of appetite and mental disorders, inexperienced caregivers tend to ignore the above symptoms leading to the missed diagnosis and inappropriate use of antibiotics, increasing disability. 48% of US isolates of S. pneumoniae tested were macrolide-resistant in 2014 (an increase from the 40% reported in 2008), and high-level macrolide resistance across the US was 33% (Jones et al, 2010). This is the case in Europe (Ales et al, 2013). Due to the high prevalence of LRTIs in the elderly both in hospital and outpatient setting (Table 1), the epidemiological differences, atypical clinical manifestations, and age-related variations in pharmacokinetics and pharmacodynamics make LRTIs management for the elderly more challenging, and standardized treatment at early stage of LRTIs is critical to reducing deaths and disability at present
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