- The role of antibiotics
- What causes adverse drug events among the elderly?
- What are 5 drugs to avoid in the elderly?
Aging is associated with a progressive decline of body tissues which results in a slow-down of physical and mental function. In addition, seniors are often at a higher risk of chronic diseases. Moreover, many seniors already suffer from multiple comorbidities and require multiple medications and interventions. But are there antibiotic side effects in the elderly? Let’s look into it.
The role of antibiotics
Antibiotics treat or prevent bacterial infections of the many that are currently present in our everyday lives. Each antibiotic is developed to treat a specific bacterial infection. However, these medications are not without side effects as they can affect seniors with multiple chronic conditions. Generally, side effects are not expected to be serious. In some cases, some people may suffer very severe effects that they may need medical intervention. Common side effects like drowsiness, nausea, and stomach pains in seniors may happen, but these clear out after a few days.
Antibiotics work by killing bacteria that cause infection in humans. The human body is host to many bacteria therefore it is not uncommon to get infections in any part of the body including the throat, lungs, stomach, and urinary tract. Most bacteria in our bodies are useful as they aid digestion, but some cause infections such as UTIs (urinary tract infections), skin, eye and ear infections.
However, the side effects of the antibiotics used to treat bacterial infections sometimes are more problematic for seniors than for other people. Antibiotics should never be used to treat viral infections like flu and colds.
People who are more at risk of bacterial infections and may require antibiotic medication include:
- Seniors above 75
- People with a weak immune system
- People suffering from diabetes who regularly take insulin
- People who are suffering from heart failure
What causes adverse drug events among the elderly?
At least 35% of high-risk senior outpatients experience antibiotic side effects. Long-term medication especially those used for treating chronic illnesses can present adverse effects and should be monitored closely. Older adults are even more susceptible to adverse drug reactions because they take more drugs for multiple conditions.
There are several other reasons why seniors are highly likely to experience adverse drug reactions including:
- Inappropriate medication prescription (IMP) when there is evidence for an effective alternative. IMP can be categorized as underprescription, overprescription, or misprescription of medication.
- A declining liver function is where the liver no longer has the ability to process certain drugs, especially drugs used for treating blood pressure and heart conditions.
- A decline in the ability of the kidney to eliminate administered drugs from the body.
- Presence of conditions that alter drug response.
What are the most common side effects of antibiotics?
While the term adverse drug reaction (ADR) has often been used interchangeably with side effects, the two are slightly different.
What is ADR?
ADR is a harmful reaction to medication intervention always coming as a warning to withdraw or alter future administration of the medication due to the high risk it poses to the patient.
What is “antibiotic side effects”?
Antibiotic side effects, on the other hand, are milder effects that people experience after taking antibiotics which clear within a few days. The antibiotic side effects female and male populations experience are generally similar.
The elderly are more vulnerable to adverse drug reactions compared to other populations like youth and adults. This is because aging is associated with comorbidity, loss of or reduced physiological reserve, and polypharmacy. For instance, a senior suffering from more than three chronic conditions and is on more than five medications is highly likely to experience adverse drug effects.
Common drug side effects in the elderly usually affect the digestive system and this happens to 1 in every 10 people.
Common side effects in the elderly are:
Digestive system side effects
Side effects affecting the digestive system are normally mild and should clear with time. They include:
- Appetite loss
- Stomach pain
Fewer people, about 1 in every 5 people experience allergic reactions after taking antibiotics such as cephalosporins and penicillin. Side effects related to allergic reactions are also usually mild and should clear within a short time after administering antihistamines. They include:
- Skin rash
- Tightness of the throat
Joints, muscles, and bones side effects
Some 10% to 15 % of seniors will experience side effects in the muscles, bones, joints, and even nervous system after taking statins (used to treat high cholesterol), proton pump inhibitors, acid reflux medications, fluoroquinolone, and benzodiazepine receptor agonists.
Side effects include:
- Weak aching muscles are also referred to as myopathy or rhabdomyolysis if the side effects are severe. Mythpathy often disappears once one stops the medication
- Joint pain
- Bone loss and fractures due to blocked calcium absorption
- High potassium levels in the blood usually present as general weakness, irregular heart rhythm, numbness, and a tingling sensation
- Low sodium levels symptomized by nausea and dizziness
- Nerve impairment commonly referred to as peripheral neuropathy in medical terms
- Falls, high risk of fractures, and delirium
- Gastrointestinal bleeding, heart failure, and peptic ulcer disease
What are 5 drugs to avoid in the elderly?
Seniors tend to be more sensitive to certain drugs depending on the chronic conditions that they are suffering from. Both seniors and their medical practitioners should be well informed about and be cautious about administering drugs with a high likelihood of adverse reactions. It is best to seek alternative low-risk medications.
Here are five medications that older people should be cautious about taking:
Levofloxacin and ciprofloxacin
These drugs fall under the fluoroquinolone group of antibiotics and are indicated for the treatment of a range of bacterial infections including UTIs (urinary tract infections), chest infections including pneumonia, skin infections, eye infections, ear infections, and others.
In addition to the common side effects like nerve damage and peripheral neuropathy, these drugs may also cause,
- Bloating and constipation
- Difficulty sleeping and restlessness
- Tendon, joint, or muscle pain
- Numbness or tingling sensation
In 2016, the FDA issued a warning recommended against using fluoroquinolone drugs for treating UTIs and acute sinus infections unless there are no other options.
NSAIDs (Non-steroidal inflammatory drugs)
This class of drugs includes such drugs as ibuprofen (Advil and Motrin), naproxen (Aleve), and aspirin increases the risk of heart failure, blood pressure, and peptic ulcers, gastrointestinal bleeding in seniors. NSAIDs should be avoided especially by seniors aged 75 years and above due to the highly hazardous side effects including acute kidney damage that are associated with them.
The FDA has warned against all NSAIDs given the cardiovascular risks they pose to patients.
Zolpidem (Ambien) is a hypnotic that falls under the benzodiazepine receptor agonists class of drugs. Other similar drugs in this class are eszopiclone (Lunesta) and Zaleplon (Sonata), administered for insomnia cases. Zolpidem side effects include drowsiness, dizziness, lightheadedness, loss of balance, fatigue, and headache. These drugs are not recommended for use by the elderly because they increase the risk of falls, fractures, delirium, and motor accidents and the elderly are more at risk.
Ideally, medications for treating insomnia and other sleep disorders are not recommended for the elderly. Non-invasive intervention programs such as cognitive behavioral therapy, exercise, and relaxation therapy are good alternatives.
While first-generation antihistamines like Benadryl are indicated for treating allergies, they cause drowsiness and are thus often used as an over-the-counter medication for insomnia. Benadryl also falls in the anticholinergic class of drugs advanced for treating mental health and bladder disease. Benadryl contains diphenhydramine which has adverse side effects on seniors. Such effects as dementia, delirium, confusion, dizziness, blurred vision, and other effects associated with cognitive function.
Megestrol is a progestin class of drugs used to treat breast cancer and endometrial cancer. It is also used as a remedy for loss of appetite and severe weight loss in AIDS patients. However, it is not recommended for use by the elderly. This is because Megestrol is excreted through the kidneys yet as they age, seniors experience declined kidney function. Accumulation of megestrol in the system increases the chances of toxicity.
Medications and especially antibiotics are helpful in treating infections. However, you should take extra caution when prescribing antibiotics for older patients especially those who are taking multiple drugs for multiple diseases. Patients, on the other hand, should take medication as prescribed by their doctors. When wrongly used or overused, antibiotic side effects in the elderly can be serious.