Anti-infective drugs are used in the frail elderly population, pay attention to these safety issues!

Multidosing in frail older adults is associated with
increased serious adverse events (falls, cognitive impairment, functional decline, prolonged hospital stay, and risk of rehospitalization and death).
The purpose of the Chinese Expert Consensus on the Safety Management of Multimedication in the Frail Elderly in Integrated Medical and Nursing Care Institutions (2022 Edition) is to guide the early screening, assessment, management and individualized comprehensive intervention
of adverse reactions caused by multiple medication in the frail elderly in integrated medical and nursing care institutions.
Regarding the use of anti-infective drugs for the frail elderly, the consensus mainly puts forward the following safety warnings
.

Safety warning of anti-infective drugs in frail elderly

➤ Antibacterial antibiotics

Penicillin drugs should not be combined with telmicocin, chloramphenicol, erythromycin, sulfonamides, etc.
; Penicillin combined with warfarin can increase the effect of anticoagulants and increase the risk of bleeding, which should be monitored
.

Cephalosporins are equivalent to strong diuretics (furosemide, edinylic acid, bumetanide, etc.
), antineoplastic drugs (carzozac, streptocin, etc.
) and aminoglycoside antibiotics, which can increase nephrotoxicity; In combination with polymyxin E, polymyxin B and vancomycin, nephrotoxicity can be aggravated; In combination with non-steroidal anti-inflammatory analgesics, antiplatelet drugs, etc.
, platelet inhibition is enhanced and the risk of
bleeding is increased.

Cephalosporins, metronidazole, β-endophthalamines are taken at the same time as alcohol, due to acetaldehyde accumulation, resulting in disulfiram reaction, severe blood pressure drop and even shock
.

β-endophthalamine drugs combined with strong diuretics such as furosemide can increase nephrotoxicity; In combination with heparin and warfarin, it increases the risk of
bleeding.

Aminoglycosides combined with plasma substitutes (dextran), diuretics (furosemide), erythromycin and capreomycin, cisplatin, vancomycin, norvancomycin, etc.
, can increase ototoxicity and nephrotoxicity, causing hearing damage; Combination with polymyxins can also increase nephrotoxicity; In combination with diazepam, benzodiazepine, quinidine, etc.
, it can lead to muscle weakness, respiratory depression or respiratory muscle paralysis
.

Macrolides, such as azithromycin, clarithromycin, etc.
, are combined with carbamazepine, cyclosporine, digoxin, tacrolimus, phenytoin, afentanib, cisapride , disopyramide, lovastatin, bromocriptine, sodium valproate, etc.
, and are prone to adverse reactions; In combination with terfenadine and asimizole, the electrocardiogram Q-T interval is prolonged, and torsades de pointes are prone to occur; In combination with lovastatin, the risk of rhabdomyolysis increases; In combination with warfarin (long-term use), it increases the risk of
bleeding.

Fluoroquinolones combined with theophylline drugs are easy to cause theophylline poisoning; It should not be used with drugs containing aluminum and magnesium and calcium, iron and zinc; Combination with nonsteroidal anti-inflammatory drugs (eg, indomethacin, ibuprofen, piroxicam) will produce drug antagonism; In combination with rifampicin and nitrofurantoin, it can antagonize the pharmacological effects of fluoroquinols; When combined with calcium channel blockers (nifenopyridine), it will affect the blood concentration of fluoroquinolones; In combination with sucralfate and antacids, the absorption rate of fluoroquinolones can be slowed down by 25%; With alkaline drugs, anticholinergics, and H2 receptor antagonists (such as ranitidine, famotidine, cimetidine, etc.
), it can slow the excretion of fluoroquinolones and easily form drug accumulation
.

➤ Antifungal drugs

Amphotericin B in combination with aminoglycosides can increase nephrotoxic effects; In combination with amiodarone, asimizole, quinidine, sotalol, sparfloxacin, sutopride ride, terfenadine, vincamine, etc.
, it can cause hypokalemia, ECG Q-T interval prolongation leading to torsades de pointes, bradycardia, etc.
; In combination with digitalis, hypokalemia is easy to cause digitalis poisoning
.

Fluconazole in combination with oral warfarin increases the risk of bleeding; In combination with sulfonylurea hypoglycemic drugs, hypoglycemia is prone to occur; In combination with theophylline and aminophylline, it can increase the blood concentration of theophylline and increase the risk
.

Itraconazole, ketoconazole, miconazole combined with warfarin increases the risk of bleeding; In combination with astimazole, terfenadine, cisapride increases the risk of ventricular arrhythmias (torsades de pointes); In combination with digoxin, it can increase the concentration of digoxin and cause digoxin poisoning; In combination with midazolam and triazolam, it significantly enhances its sedative effect
.

Ketoconazole combined with ethanol or drinking strong liquor can cause disulfiram-like effects, so concomitant use of alcoholic beverages and drugs
should be avoided.

Click to read the original consensus article

The above content is excerpted from: "Chinese Expert Consensus on the Safety Management of Multiple Drugs for the Frail Elderly in Integrated Medical and Nursing Care Institutions (Edition)" Writing Group, Chinese Geriatric Society Integrated Medical and Nursing Care Promotion Committee.
Chinese expert consensus on the safety management of multiple drugs in the frail elderly in integrated medical and nursing care institutions (2022 edition)[J].
Chinese Journal of Cardiovascular Disease,2022,27(5):403-410.