By Thomas Yoshikawa, Dean Norman

Because getting older is followed by means of a gentle decline in resistance to infectious ailments, the prognosis and therapy of those ailments within the aged isn't just even more complicated, but additionally usually rather various from that for more youthful patients.

In the second one variation of Infectious ailment within the getting older: A medical Handbook, a panel of popular and hugely skilled geriatric physicians and infectious ailment specialists overview crucial universal infections affecting the aged and delineate their well-proven diagnostic, healing, and preventive ideas. one of the health problems mentioned are urinary tract infections, pneumonia, ocular infections, tuberculosis, and fungal and viral infections. moreover, there are unique discussions of sepsis, infective endocarditis, intraabdominal infections, bacterial meningitis, osteomyelitis and septic arthritis, and prosthetic machine infections.

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In elderly patients with this infection, not only is S. pneumoniae recovered but Gram–negative bacilli and Listeria monocytogenes are relatively common meningopathogens; viral meningitis is distinctly uncommon (Chapter 11). Consequently, in elderly meningitis patients, initial empiric treatment must include antibiotics active against these three types of bacteria. From: Infectious Disease in the Aging Edited by: Thomas T. Yoshikawa and Dean C. , Totowa, NJ 19 20 Doo and Yoshikawa Select age–related physiological changes impact on the pharmacokinetics and pharmacodynamics of drugs in general.

The recent incidence and mortality of sepsis in the elderly are not available from the national databases. However, the death certificate data from 1980 and 1992 showed that there was a 25% increase in the rate of infectious disease deaths, and the persons aged 65 yr and older had the highest death rate (13). Two possible explanations for this increase could be increasing awareness of physicians and the real increasing risk of sepsis. The mortality rate from the death certificate data could be overestimated because there were comorbidities independent of the occurrence of sepsis in about 50% of all septic patients, and severe underlying diseases could be found in up to 95% (10,14).

However, whenever possible, specific directed therapy based on microbiological findings should be initiated. Indiscriminate use of such broad–spectrum antibiotics will invariably lead to multidrug–resistant organisms, which is already a growing problem in long–term care facilities (12) (see Chapter 21). REFERENCES 1. T. (1990) Antimicrobial therapy for the elderly patient. J. Am. Geriatr. Soc. 38, 1353–1372. 2. D. (1992) Antimicrobial therapy. Clin. Geriatr. Med. 8(4), 925–945. 3. T. C. ) (1994) Antimicrobial Therapy in the Elderly Patient, Marcel Dekker, New York.

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