Appropriateness Of Antibiotic Prescription: The Elderly Patient

Appropriateness of prescription is a cornerstone of research in the geriatric field. Metabolic changes, multimorbidity and complex regimens of treatment are responsible for the high incidence of iatrogenic events among the elderly. Moreover, aging predisposes to the development of infectious diseases, making the elders frequent users of antibiotics. Fluoroquinolones appear to be among the most prescribed, both in hospital and community settings, as first-choice drugs in the treatment of respiratory and urinary tract infections. However, some side effects of fluoroquinolones (i.e. lowering seizure threshold and pro-arrhythmic effect), restrict its use in frail elderly patients. In this regard, recent data have shown the superiority of prulifloxacin (prodrug of ulifloxacin), a fluoroquinolone recently discovered, both in terms of efficacy and safety. In particular, prulifloxacin, showed greater inhibitory power against Pseudomonas and Streptococcus, compared to other fluoroquinolones, ensuring a broader spectrum of action and a lower induction of resistance. In addition, the reduced crossing of the blood-brain barrier by prulifloxacin reduces the risk of adverse events such as epilepsy, headache and confusion, thus limiting the risk of falling and other dangerous events. Still, prulifloxacin has been shown to not significantly impact on QT-interval duration, thus reducing the proarrhythmic effect associated with other fluoroquinolones. Such characteristics make prulifloxacin a drug with a remarkable safety profile, suitable for use in frail elderly populations.