Antibiotic therapy of intra-abdominal sepsis in the elderly: experience with ticarcillin and clavulanic acid.

Age is a major factor in determining the outcome for older patients with intra-abdominal sepsis. Poor outcome in these patients may be related to a number of physiologic and immunologic changes associated with aging. The treatment of intra-abdominal sepsis can itself pose special risks for the elderly. Standard regimens containing aminoglycosides have a substantial risk of nephrotoxicity, which is magnified in elderly patients. Alternatives to standard aminoglycoside-containing regimens, therefore, are desirable. Most intra-abdominal infections involve multiple pathogens, usually both aerobic and anaerobic. The polymicrobial nature of intra-abdominal sepsis mandates antimicrobial chemotherapy effective against a broad range of organisms. In the past several years, a host of new antibiotics have been introduced that used alone or in combination with other drugs has the potential of safely avoiding aminoglycosides in many patients with intra-abdominal sepsis. One such agent, ticarcillin with clavulanate potassium, is active against a wide spectrum of aerobic and anaerobic pathogens. In a prospective, randomized, open label trial, ticarcillin and clavulanate was compared with gentamicin and clindamycin. Although the sample size was too small to allow meaningful statistical comparisons of efficacy and safety, both regimens were effective and well tolerated. In general, prolonged administration of aminoglycosides is rarely indicated for the treatment of intra-abdominal sepsis in the elderly, although initial empiric use of aminoglycosides may sometimes be warranted.