title: How Antibiotics Should be Prescribed to Hospitalized Elderly Patients with Community-Acquired Pneumonia.
abstract: 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.
authors.affiliation: Division of Infectious Diseases, School of Medicine, University of Louisville, 501 E. Broadway, Suite 140 B, Louisville, KY, 40202, USA. f.arnold@louisville.edu.
authors.forename: Forest W
authors.initials: FW
authors.lastname: Arnold
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy; D004334:Drug Administration Schedule; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D024841:Fluoroquinolones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage; D018942:Macrolides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D017410:Practice Guidelines as Topic; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D061665:Time-to-Treatment; D047090:beta-Lactams / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D007252:Influenza Vaccines; D018942:Macrolides; D022242:Pneumococcal Vaccines; D047090:beta-Lactams