Meyers B R, Wilkinson P
Division of Infectious Diseases, Mount Sinai Medical Center, New York, New York.
Clin Pharmacokinet. 1989 Dec;17(6):385-95. doi: 10.2165/00003088-198917060-00003.
A review of the clinical pharmacokinetics of antibiotics in the healthy elderly reveals that for most compounds a decrease occurs in renal clearance (associated with age-related decreases in renal function), as well as a prolonged half-life and increased area under the plasma concentration-time curve. These changes are amplified in the sick infected elderly. It is important that the treating physician be aware of the potential side-effects of antimicrobial agents, and whenever possible choose those which are associated with the least adverse effects. Individual patient variability, including underlying diseases and other prescribed medications, must be taken into account when dosage is selected. beta-Lactam compounds have a remarkable safety record: specifically in the elderly, their therapeutic/toxic ratio is much higher than that observed with aminoglycosides. Regimens for this class of drugs in the elderly should maintain antibiotic concentrations above the minimum inhibitory concentrations for maximum efficacy. In the treatment of elderly patients, it is suggested that dosage and interval be based on estimated or measured creatinine clearance. Usually, for drugs that are excreted primarily by the kidney (i.e. amino-glycosides, beta-lactams and quinolones), dosage intervals must be increased when there is an associated fall in creatinine clearance. The pharmacokinetic parameters suggest that as an alternative to increasing dosage interval the usual dose may be decreased, but further studies are necessary for confirmation.
对健康老年人抗生素临床药代动力学的综述表明，对于大多数化合物，肾清除率会下降（与年龄相关的肾功能下降有关），同时半衰期延长，血浆浓度-时间曲线下面积增加。这些变化在患病感染的老年人中会更明显。治疗医生必须了解抗菌药物的潜在副作用，并尽可能选择那些副作用最小的药物。选择剂量时，必须考虑个体患者的差异，包括基础疾病和其他正在服用的药物。β-内酰胺类化合物有出色的安全记录：特别是在老年人中，它们的治疗/毒性比远高于氨基糖苷类药物。老年人使用这类药物的治疗方案应使抗生素浓度维持在最低抑菌浓度以上，以达到最大疗效。在治疗老年患者时，建议根据估算或测量的肌酐清除率来确定剂量和给药间隔。通常，对于主要经肾脏排泄的药物（即氨基糖苷类、β-内酰胺类和喹诺酮类），当肌酐清除率下降时，给药间隔必须延长。药代动力学参数表明，作为延长给药间隔的替代方法，可以降低常用剂量，但需要进一步研究加以证实。
