Antimicrobial treatment of bacterial infections in frail elderly patients: the difficult balance between efficacy, safety and tolerability

• Macrolide prescription may cause rhabdomyolysis in elderly patients taking statins.
• Antimicrobials may cause significant bleeding events in elderly taking warfarin.
• Antimicrobials may cause severe hypoglicemic events in diabetic elderly patients.
• Dose reduction of renally cleared antimicrobials is needed in kidney disease.

The elderly population is increasing worldwide and shows an increasing prevalence of frailty. Frailty is recognized as an important factor for inappropriate drug prescribing in elderly patients. Appropriate drug prescription, either in terms of drug choice or in terms of drug dosage, is of paramount importance among the frail elderly patients, this requiring the need of a difficult balance between efficacy, safety and tolerability. Bacterial infections are quite frequent among the elderly, and use of antimicrobials may be associated with severe adverse events in this population, especially when in presence of co-medications and/or of co-morbidities. The aim of this paper is to argue about the most recent published evidences on how to prevent major adverse events whenever antimicrobials should be co-prescribed in frail elderly patients.