Common antibacterial treatment for older persons: balancing efficacy with tolerance

With age, older persons experience a gradual deterioration in their physical functioning and a number of changes in their physical state, which makes them uniquely challenged in the course of antibacterial treatment. In choosing antibacterial treatment for older persons, the relationship between efficacy and tolerance must be carefully weighed to ensure the safety and effectiveness of treatment, improve the quality of life of older persons and promote their health recovery.I. Physiological characteristics of older persons and links to antibacterial treatment(i) Declining liver and kidney functionThe reduction of liver size, reduction of liver blood flow and reduction of the metabolic function of liver cells among older persons has led to the slowing down of metabolism in the liver, higher blood concentrations and longer half-lives for many antibacterial drugs. For example, the metabolic process in older persons can be significantly affected by a number of liver metabolisms of β-neamide antibiotics, such as thalamus. At the same time, the kidney function of the elderly has been declining, the rate of filtration of the kidney ball has been reduced, and the distribution and heavy absorption of the kidney tube has been reduced. This has made it easier for renal excretion of antibacterial drugs, such as aminocin antibiotics (Gypnocin, Amikane, etc.), to accumulate in the body and has increased the risk of adverse drug reactions, such as further damage to kidney function due to renal toxicity.(ii) Inadequate immunization functionThe immune system of older persons is relatively weak, the activity and number of immunocellular cells are reduced and the immune response capacity is reduced. This tends to make them more serious when faced with bacterial infection and to recover from infection for longer periods. For example, pneumonia is high among older persons and has a relatively high rate of death. In anti-bacterial treatment, consideration needs to be given to the choice of medicines that can rapidly and effectively control infections and enhance immune functions, while also avoiding aggravating conditions as a result of drug inhibition of the immune system.(iii) Combining basic diseasesOlder persons often combine a variety of chronic diseases, such as cardiovascular diseases, diabetes and respiratory diseases. These underlying diseases affect the choice and use of antibacterial drugs. For example, older persons with diabetes, because of fluctuations in their blood sugar levels, may affect the metabolic and therapeutic effects of drugs, and some antibacterial drugs may have an impact on blood sugar, such as the replacement of salsa, which can lead to abnormal increases or decreases in blood sugar. In addition, older persons who combine cardiovascular diseases need to consider the effect of drugs on heart function and blood pressure when using certain antibacterial drugs, such as esters of the Great Ring, which can cause heart disorders.II. Principles for the selection of antibacterial drugs that combine efficacy with resistance(i) Precision diagnosis, identification of pathogensIt is important to diagnose infectious diseases as accurately as possible and to identify pathogenic agents before antibacterial treatment begins. This needs to be combined with the symptoms, signs, medical history of the elderly and the relevant laboratory examinations, such as blood routines, sting culture, urine culture, blood culture, etc. Targeted choice of anti-bacterial drugs can only be achieved by identifying pathogens and increasing the responsiveness and effectiveness of treatment. For example, in the case of older pneumonia patients, if the streptococcus is shown to be pneumococcus infection, the preferred antibacterial drugs that are sensitive to pneumococococcus, such as penicillin or precipitin antibiotics, avoid blind use of broad spectrum antibacterial drugs and reduce unnecessary adverse reactions and resistance.(ii) Choosing drugs based on pharmaceutical dynamicsIn view of the reduction of liver and kidney function in the elderly, priority should be given to antibacterial drugs that have less impact on the liver and kidney function, or to the adjustment of the dose to the liver and kidney function indicator. In the case of older persons with mild liver or kidney impairment, the dose may be reduced or the interval between drugs may be extended as appropriate; in the case of patients with severe liver and kidney deficiencies, the choice may be made for substances excreted by means other than the liver or kidney, or the dose may be adjusted by means such as dialysis. For example, in the case of elderly patients with incomplete kidneys, the use of thalamus should be adjusted to the acetic anhydride removal rate in order to avoid an increase in kidney toxicity due to the accumulation of drugs in the body. For some of the main liver metabolic drugs, such as erythrin, care should be taken in the case of older persons with impaired liver function and hepatic function should be closely monitored.(iii) Concern about the adverse effects of drugsOlder persons are less resistant to adverse drug responses, so that their potential adverse effects are fully taken into account in the selection of antibacterial drugs. Avoiding the use of drugs with obvious ear toxicity, kidney toxicity, neurotoxicity and other adverse effects, such as amino-clucose antibiotics in the elderly, should be extremely cautious and should be used with close monitoring of kidney function and hearing, unless there are clear indications of use and no other suitable alternative. At the same time, attention needs to be paid to the interaction between drugs, where older persons are often treated with multiple drugs for underlying diseases, and where some antibacterial drugs may interact with other drugs, affecting the efficacy of treatment or increasing the risk of adverse reactions. For example, the combination of quinone-like antibiotics with antiacids with metal ions such as aluminium, magnesium and other metals affects their absorption and reduces their therapeutic efficacy and should be avoided.(iv) Integrated assessment, individualized treatmentAn integrated assessment of the overall health status of older persons, underlying diseases, and self-care capacity is carried out, and individualized antibacterial treatment programmes are developed. For older persons who are in better physical condition and with less basic diseases, relatively conventional antibacterial treatment options are available, but still need to be closely monitored; for older persons who are weak and combine many serious basic diseases, highly safe, resistant antibacterial drugs should be selected, and support for treatment and adverse response monitoring should be strengthened. For example, in the selection of anti-bacterial drugs, priority should be given to anti-bacterials for a person suffering from hypertension, diabetes mellitus and relatively weak older pneumonia, to medicines that have a lower impact on cardiovascular and blood sugar and have a low level of adverse reaction, such as biobiotics for the head of a herbicide, and to close monitoring of blood pressure, blood sugar changes and the adverse effects of the drug during treatment.Monitoring and adjustment during treatment(i) Medical effectiveness monitoringIn the course of antibacterial treatment, the improvement of the symptoms of older persons, such as reduced body temperature, reduced coughing and reduced coughing, is closely observed, and the efficacy of antibacterial treatment is assessed in conjunction with the results of laboratory examinations, such as changes in the white-cell count and the percentage of the neutral particle in blood routines, and the transfer of abdomen or blood culture. If the treatment is not effective, it should be analysed in a timely manner, possibly because of the pathogen’s resistance to the selected drug, the insufficient dose of the drug, the inadequate treatment process, etc., and the adaptation of treatment programmes to specific circumstances, such as the replacement of antibacterial drugs, an increase in the dose or an extension of the treatment.(ii) Monitoring of adverse effectsIndicators such as liver and kidney function, blood routines, electrocardiograms, etc. of the elderly are regularly monitored, as well as to observe signs of adverse medical reactions such as rashes, itching, nausea, vomiting, diarrhoea, dizziness, ringing, etc. Once the adverse effects are detected, the drugs should be stopped and appropriate measures taken to address them according to their severity. For example, in the case of mild rashes, allergies can be treated and closely observed; in the case of severe liver and kidney impairment, liver, kidney and antibacterial treatment programmes may be required.(iii) Adjustment of treatment programmesThe antibacterial treatment programme is adjusted in a timely manner based on the results of the effects and adverse effects monitoring. In adjusting programmes, the physical condition and durability of older persons should be fully taken into account, with a view to choosing more appropriate antibacterial drugs or adjusting their dose, route of delivery, course of treatment, etc. For example, if an elderly patient has had a serious gastrointestinal reaction following the use of an anti-bacterial drug and is unable to withstand continued oral treatment, consideration may be given to changing it to an intravenous drug or to a similar drug with a lower gastrointestinal reaction.Antibacterial treatment for older persons is a complex and detailed process, requiring doctors to take full account of the physical characteristics of older persons, underlying diseases, drug resistance, etc., and to carefully select antibacterial drugs and closely monitor the treatment process in order to achieve the best balance between efficacy and tolerance and to safeguard the health of older persons.