Medicus, Vol. 14 No. 1_ARI, 2005.
Review article
Contemporary Treatment of Pneumonias in the Elderly
Ema Mušič
Abstract
Pneumonia ranks fourth among causes
of death in the elderly, i.e. in patients over 65 years of
age. Risk factors in this age group include accompanying
chronic diseases, compromised mucociliary clearance,
reduced general and specifi c defence mechanisms, frequent
nasopharyngeal colonization, weakened physical and mental
state, as well as poor social and hygienic conditions.
Clinical picture of pneumonia is not always typical. Hypoxia
caused by pneumonia rapidly alters a patient’s mental and
physical status.
A new approach introduced in the treatment of pneumonia in
the elderly includes the assessment of disease severity, i.e.
the assessment of risk factors. In addition to the U.S. score
system PORT (Pneumonia Outcome Research Team), the
British score system CURB (Confusion, Urea, Respiratory
rate, Blood Pressure), as well as the CURB-65 version for
people over 65 years of age, is also available. A simple
use of these score systems signifi cantly helps in making
a decision on hospital or outpatient treatment and choice
of medicines, especially antibiotics. This article provides
guidelines for outpatient and hospital treatment.
The proper choice of antibiotics is very important. If
accompanying conditions allow oral use, patients should
be treated at home. Amoxicillin with clavulanic acid or
respiratory quinolones most often represent the antibiotics
of choice in the treatment of elderly patients since less
severe forms of pneumonia without accompanying chronic
diseases have been reported very rarely. Second or third
generation cephalosporin antibiotics can be also used.
The addition of a macrolide antibiotic is recommended in
special epidemiological circumstances and for patients with
a more severe clinical picture, as well as in the treatment
of pneumococcal pneumonia with penicillin. If the initial
therapy does not yield satisfactory results or if causative
agents are rare and unexpected, one should rely on the
available microbiological tests.
Keywords
pneumonia; elderly patients; treatment; guideline
Hrčak ID:
18826
URI
Publication date:
26.1.2005.
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