title: Participation of elderly adults in randomized controlled trials addressing antibiotic treatment of pneumonia.
abstract: OBJECTIVE
  To examine how relevant current evidence on antibiotic treatment of pneumonia is for elderly adults.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Randomized controlled trials (RCTs; N = 43) comparing different antibiotics and prospective observational studies (N = 182) published since 2005.
  
  
  METHODS
  Adults with community-acquired (CAP), healthcare-associated (HCAP), hospital-acquired (HAP), or ventilator-associated (VAP) pneumonia.
  
  
  METHODS
  Exclusion criteria that could preferentially limit participation of elderly adults were examined, subgroup or other adjusted analyses were searched for according to age, and treatment effects in participants younger than 65 in RCTs were compared with those in participants aged 65 and older. Mean participant ages in RCTs and observational studies were compared. Risk ratios (RRs) with 95% confidence intervals (CIs) for differences between older and younger adults were pooled using a fixed effect metaanalysis.
  
  
  RESULTS
  No RCT reported exclusion based on an upper age limit; 100% of community CAP trials, 90% of hospitalized CAP trials, and 76% of HAP and VAP trials excluded individuals based on comorbidities. None of the RCTs reported a subgroup analysis for mortality according to age. The RR for the pooled difference in treatment failure rates between participants younger than 65 and those aged 65 and older was 1.25 (95% CI = 0.94-1.65, 12 RCTs) and between participants younger than 75 and aged 75 and older was 1.43 (95% CI = 0.98-2.09, 7 RCTs). RCT participants were significantly younger (54.0 ± 9.6) than those in observational studies of CAP (66.2 ± 8.1, P < .001). Age differences were not significant for HCAP, HAP, and VAP.
  
  
  CONCLUSIONS
  Elderly adults are often excluded from RCTs of bacterial pneumonia. No data were found on the comparative efficacy of antibiotic treatment in elderly adults and the general population.
authors: Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital and Sackler Faculty of Medicine, Tel-Aviv University, Israel.
authors: Tomer
authors: T
authors: Avni
authors: Shahaf
authors: S
authors: Shiver-Ofer
authors: Leonard
authors: L
authors: Leibovici
authors: Evelina
authors: E
authors: Tacconelli
authors: Giulia
authors: G
authors: DeAngelis
authors: Barry
authors: B
authors: Cookson
authors: Leonardo
authors: L
authors: Pagani
authors: Mical
authors: M
authors: Paul
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D018579:Patient Selection; D011014:Pneumonia / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000900:Anti-Bacterial Agents
keywords: elderly; pneumonia; systematic review