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Several age-related changes contribute to the high incidence of infections in geriatric patients. There appears to be a reduction in host defenses in the elderly, manifested in the increase in both serious infections and cancer. This may reflect an alteration in T-lymphocyte function. In the lungs, a major age and tobacco-dependent decrease in mucociliary clearance significantly increases susceptibility to infection. In the urinary tract, the incidence of serious infection is greatly increased by urinary retention and catheterization in men.
Since 1940, the antimicrobial drugs have contributed more to the prolongation of life than any other drug group because they can compensate to some extent for this deterioration in natural defenses. The basic principles of therapy of the elderly with these agents are no different from those applicable in younger patients and have been presented. The major pharmacoki-netic changes relate to decreased renal function; because most of the β-lactam, aminoglycoside, and fluoroquinolone antibiotics are excreted by this route, important changes in half-life may be expected. This is particularly important in the case of the amino-glycosides, because they cause concentration- and time-dependent toxicity in the kidney and in other organs. The half-lives of gen-tamicin, kanamycin, and netilmicin are more than doubled. The increase may not be so marked for tobramycin.
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