Arnold Forest W
Division of Infectious Diseases, School of Medicine, University of Louisville, 501 E. Broadway, Suite 140 B, Louisville, KY, 40202, USA.
Drugs Aging. 2017 Jan;34(1):13-20. doi: 10.1007/s40266-016-0423-9.
Elderly patients hospitalized with community-acquired pneumonia (CAP) should be administered antimicrobials in the emergency department prior to transfer to the ward or intensive care unit (ICU). For ward patients, a β-lactam with a macrolide or a respiratory fluoroquinolone alone should be given to cover typical and atypical pathogens. For ICU patients, a β-lactam with either a macrolide or a fluoroquinolone should be given. Other regimens are indicated if methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa is a concern. Patients who are hemodynamically stable and can tolerate oral intake can be considered for switch therapy as well as discharge if other co-morbidities are stable and a safe disposition plan exists. A number of special concerns for the elderly include noting adverse effects from antimicrobials, being watchful of comorbidity exacerbations, and vaccinating for pneumococcus and influenza.
因社区获得性肺炎（CAP）住院的老年患者，在转至病房或重症监护病房（ICU）之前，应在急诊科给予抗菌药物治疗。对于病房患者，应给予β-内酰胺类药物联合大环内酯类药物或单独使用呼吸喹诺酮类药物，以覆盖典型和非典型病原体。对于ICU患者，应给予β-内酰胺类药物联合大环内酯类药物或喹诺酮类药物。如果怀疑有耐甲氧西林金黄色葡萄球菌或铜绿假单胞菌感染，则应采用其他治疗方案。血流动力学稳定且能够耐受口服给药的患者，如果其他合并症稳定且有安全的出院计划，也可考虑采用序贯治疗并出院。老年人还有一些特殊注意事项，包括关注抗菌药物的不良反应、警惕合并症加重，以及接种肺炎球菌疫苗和流感疫苗。
