Keywords: pneumonia in the elderly
Early antibiotic treatment can reduce the mortality rate of pneumonia in the elderly. Although clear the pathogen and its sensitivity to the drug, targeted therapy is the most reasonable, but often due to critical condition without and wait for the results of sputum or sputum has not yet obtained pathogens, you can, according to the hospital, outside the bacterial infection The law of the empirical selection has a strong bactericidal effect of antibiotic treatment are also quite necessary.
Outside the hospital-acquired pneumonia, though still common pathogens Streptococcus pneumoniae, but treatment must take into account the treatment of Gram-negative bacilli. Penicillin have a strong effect on Gram-positive cocci and anaerobic bacteria in addition to the Bacteroides fragilis outside the first-generation cephalosporin drugs, or may choose. Drug-resistant Gram-negative bacilli infections fair application of the second-generation cephalosporins or beta-lactam antibiotics and aminoglycoside combination therapy. Metronidazole with strong antibacterial activity against anaerobes, one of the important drug for the treatment of aspiration pneumonia. Nosocomial pneumonia pathogens complex treatment against Gram-negative bacteria, both gram-positive bacteria, especially Staphylococcus aureus, aminoglycoside joint second generation or third generation cephalosporin drugs. Generation fluoroquinolones such as ofloxacin, ciprofloxacin, have a broad-spectrum antibacterial effect, can be used in a hospital, the outer infection. Staphylococcus aureus penicillinase, has reached more than 90% resistant to penicillin, such as oxacillin, penicillin-resistant enzyme and first-generation cephalosporins; places methicillin-resistant Staphylococcus aureus (MRSA nosocomial infections ) is common, have become resistant to penicillin and penicillin-resistant enzyme, vancomycin, rifampicin, fluoroquinolones sensitive, especially vancomycin treatment effect is better. MRSA infections outside the hospital now, when found, should pay attention when considering treatment options. Imipenem is a new carbapenem antibiotic, a broad-spectrum, efficient antibacterial activity, acting on the majority of Gram-positive and Gram-negative aerobic and anaerobic bacteria, Pseudomonas aeruginosa and its easy drug resistance.
Elderly tissues and organs showed degenerative changes, poor tolerance to drugs prone to toxicity, kidney function increased with age and diminished. The normal elderly glomerular filtration rate decrease, generally more than 70-year-old elderly dosage may be reduced. Aminoglycoside antibiotics since the removal of the kidney with age significantly reduce the rise of drug accumulation in the body, the blood concentration, prone to ear, renal toxicity, improper application of these drugs in the clinical renal failure, and even cause result in death cases have been reported, so care must be taken in the application of amino sugars drugs judiciously. Medication should be for blood concentration monitoring in order to adjust the amount of medication at any time, to avoid causing kidney toxicity. Vancomycin against MRSA infection effect is very good and should be matched for blood concentration monitoring to avoid ear, kidney toxicity, medication.
Elderly critically ill pneumonia its more extensive lesions, often leads to reduce the ventilation / perfusion ratio, to generate static arterial blood mixed hypoxemia, arterial blood gas monitoring oxygen therapy to correct hypoxia. Emphasis on supportive care such as to supplement blood volume, and promptly correct the water dielectric imbalance in elderly patients with negative nitrogen balance the need to give a full high-calorie, high-protein, high vitamin diet, as appropriate, intravenous infusion of albumin, plasma amino acids or high nutrition liquid.