The incidence of
pneumonia is highest among the aged compared with other adult populations, and causes significant morbidity and mortality among this group. Most episodes of
pneumonia are caused by aspiration of oropharyngeal flora into the lungs and failure of lung defence mechanisms to eliminate the aspirated bacteria. Studies in elderly patients have shown a high rate of oropharyngeal carriage of Gram-negative bacilli and polymicrobial/mixed flora
pneumonias, especially in debilitated elderly patients in nursing homes or hospitals. This information is helpful to practitioners in prescribing empirical
antibiotic therapy for elderly patients with
pneumonia. Because of the many additional concerns which must be considered in the rational selection of an
antibiotic regimen, e.g. route of administration, compliance, drug pharmacokinetics and pharmacodynamics,
drug toxicity, and
drug-disease interactions, it is also helpful for practitioners to become familiar with a small number of the large group of available
antibiotics. Based on these considerations and the presumed bacteriology of
pneumonia in the elderly in the 3 clinical settings (community,
nursing home and hospital), a limited number of
antibiotics are recommended for empirical
antibiotic regimens for elderly patients with
pneumonia. In particular,
beta-lactamase inhibitors and
cotrimoxazole (
trimethoprim-sulfamethoxazole) are recommended, with
ciprofloxacin as an alternative agent. There is a limited role for
third-generation cephalosporins and extended-spectrum
penicillins.
Aminoglycosides are only recommended for patients with
pneumonia in the intensive care unit on
mechanical ventilation. Monotherapy (single agent) should be used whenever possible.