How to Ensure the Safety of Antibiotics for the Elderly? Reporter Lin Hui Correspondent Xing Yongtian Read Alert: Recently, there were media reports that a 92-year-old man in Taizhou, Jiangsu Province, died after being injected with two sets of antibiotics totaling 35 in 96 hours, which aroused widespread concern in the society. All tissues and organs of the elderly are undergoing degenerative changes, and the components, blood flow and physiological functions of the body have been greatly altered, resulting in various manifestations of aging. In addition to the increase of adipose tissue in the elderly, other aspects such as liver, kidney, brain blood flow, systemic water content, cardiac output, plasma proteins, renal function, etc. are seen to decrease or decline, the absorption, distribution, metabolism, excretion of drugs and their effects and the role of young people with a significant difference, and thus in the use of the drug in normal quantities, an increase in the number of adverse reactions. Pharmacy Department of Henan Provincial People’s Hospital, Zhao Ningmin So, how to use antibiotics for the elderly in order to have both therapeutic effects, but also to reduce adverse reactions? Henan Provincial People’s Hospital Pharmacy Department deputy director of pharmacist Zhao Ningmin said, the elderly in symptomatic use of antibiotics, it is appropriate to choose a lower dose, preferred cephalosporins and penicillins, if there is a clear indication of the joint use of antibiotics, the condition of the rapid or the patient’s critical condition, can be considered to joint use of antibiotics. (Small scale) the dose of medication is appropriate to choose a lower dose of “safe, effective is the goal of the rational use of drugs for the elderly.” Zhao Ningmin said, “First of all, in a comprehensive understanding of the overall health level of the elderly and drug treatment history on the basis of symptomatic use of medication, followed by strict adherence to the principle of individualization, seeking the appropriate dose, many drugs should be adjusted in the process of treatment under close observation, the length of time of the medication depending on the condition and individual response. In general, the elderly in the symptomatic use of antibiotics, the dose of medication is appropriate to choose a lower dose, that is, in accordance with the drug instructions recommended dose to take the lower value.” Zhao Ningmin suggests, “Starting from the age of 50, the dosage should be reduced by 1% of the adult dosage for every one-year increase; the dosage can generally be 1/2 to 3/4 of the adult dosage. Individual differences among the elderly are very large, and the dosage of drugs for elderly people of the same age can differ by several times. Therefore, dose individualization is particularly important. Conditional hospitals should actively carry out blood concentration monitoring, in order to more accurately adjust the dose of medication according to individual differences.” “In fact, the elderly can also use several antibiotics commonly used by children, because these drugs often have fewer toxic side effects and are suitable for the physical condition of the elderly.” Zhao Ningmin said, “Children’s commonly used oral antibiotic dosage forms include granules, syrups and tablets, the first two are generally more expensive, and older people are better off choosing tablets or capsules.” (small scale) preferred cephalosporin and penicillin “In the case of the elderly, with the aging of tissues, organ function, their adaptability gradually diminished, the incidence of adverse drug reactions is higher than that of young adults, and even some very common gastrointestinal side effects can not withstand.” Zhao Ningmin said that it is advisable for the elderly to use antibacterial drugs with low toxicity and strong bactericidal effect, preferring cephalosporins and penicillin antibiotics that have little effect on the stomach and intestines. “The elderly should try to avoid the use of toxic aminoglycosides, vancomycin and other antibacterial drugs.” Zhao Ningmin said that almost all older people have hearing loss, and aminoglycoside antibiotics such as gentamicin, streptomycin, and amikacin all have strong ototoxic effects. “Elderly people should also be careful with chloramphenicol and tetracycline antimicrobials, which is due to the decreased detoxification ability of the liver in the elderly, which can easily cause damage to liver cells and bone marrow.” Zhao Ningmin said that many older people like to use quinolone antibiotics such as norfloxacin (haloperidol), ciprofloxacin and ofloxacin, but these drugs are more stimulating to the gastrointestinal tract, so try to avoid taking them on an empty stomach, and it is best to take them half an hour after meals. So, can the elderly use a combination of multiple groups of antibiotics? Zhao Ningmin said, the elderly often suffer from multiple diseases, the use of more types of drugs. When drugs are used in combination, there will be interactions between the drugs, some of which will reduce the efficacy or failure, and some of which will increase the toxicity of the drug. Usually, the more types of drugs used in combination at the same time, the higher the incidence of adverse drug reactions. Therefore, unnecessary co-administration of drugs should be minimized, which may reduce the incidence of adverse drug reactions. However, if there is a clear indication for the combination of drugs or the condition is rapid, the joint application of antibiotics should be used, after all, it is important to save life.” (Small scale) avoid random use of antibiotics In life, due to the lack of knowledge related to antibiotics, many people, especially the elderly, there are some misconceptions about the use of antibiotics, which is one of the reasons why many antibiotics are abused. “Many older people tend to randomly take antibiotics on their own, such as amoxicillin or cefradine, and take whatever medicine they have at home. The first day to eat cefradine, to the second or third day there is little left, and then eat roxithromycin or amoxicillin, or go to the pharmacy to buy drugs to take.” Zhao Ningmin said, this not only delay the diagnosis and treatment of the condition, but also cause ineffective use of drugs and drug-resistant bacteria. Drug treatment is a coherent process, do not change drugs frequently. “Many older people can do on time and according to the amount of medication when they are sick, and once the condition is relieved, the medication will be taken at will.” Zhao Ningmin said that the efficacy of antibacterial drugs depends on their effective blood concentration, such as failing to reach the effective blood concentration, not only can not completely kill the bacteria, but will make the bacteria produce drug resistance. Therefore, the elderly in the use of antibiotics, do not arbitrarily reduce the dose of medication, or unauthorized prolongation of the interval between medication, or to shorten the course of medication. Elderly people have weakened memory and vision, so it is easy to forget to take, omit to take, take the wrong medicine, this time the family must pay great attention to this time, this time a reminder, often will solve big problems. You can’t rely solely on your physician or pharmacist to treat your illness. Older people need care from all sides.