HEALTH-FITNESS

For older adults, antibiotics pose hazards

Paula Span 
The New York Times
[JUN CHEN/THE NEW YORK TIMES]

Last month, Caryn Isaacs went to see her primary care doctor for her annual Medicare wellness visit. A patient advocate who lives in Manhattan, Isaacs, 68, expected a clean bill of health.

But her doctor, who had ordered a variety of blood and urine tests, said she had a urinary tract infection and prescribed an antibiotic. 

“The nurse said, ‘Can you take Cipro?' ” Isaacs recalled. “I didn’t have any reason not to, so I said yes.” 

There are actually plenty of reasons for older people to avoid Cipro and other antibiotics known as fluoroquinolones, which have prompted warnings from the Food and Drug Administration about their risks of serious side effects. 

And there are good reasons to avoid any antibiotic when bacteria is detected in a urine culture in a patient who has no other signs of infection. So-called asymptomatic bacteriuria increases with age, but these women are not sick and don’t need drugs. 

Yet Isaacs’ prescription was hardly unusual. Despite campaigns by the Centers for Disease Control and Prevention and other public health groups, older Americans still take too many antibiotics. 

Patients over age 65 have the highest rate of outpatient prescribing of any age group. A new CDC study, in the Journal of the American Geriatrics Society, points out that doctors write enough antibiotic prescriptions annually — nearly 52 million in 2014 — for every older person to get at least one.

“The volume would be higher if you included hospitals and nursing homes and other long-term-care settings,” said Dr. Katherine Fleming-Dutra, deputy director of the CDC’s Office of Antibiotic Stewardship. 

Antibiotic overuse contributes to a serious public health threat by creating drug resistance, as infectious bacteria adapt to the medications. Drugs then lose their effectiveness. Two million Americans get antibiotic-resistant infections annually, the CDC has reported, and 23,000 die from them. 

Moreover, antibiotics interact badly with many drugs older adults take, including statins, blood thinners, and kidney and heart medications.

Some antibiotics also have dismaying, even alarming, side effects in themselves. In 2013, the FDA issued a warning about azithromycin, which in rare cases leads to dangerous heart arrhythmias. 

But for more than a decade, the agency’s most frequent target has been fluoroquinolones.

“One of the most common problems for older adults are changes in mental status — getting anxious, getting loopy,” said Dr. Sara Cosgrove, medical director of the Johns Hopkins Hospital’s Adult Antimicrobial Stewardship Program. “These drugs get into the brain.” The FDA also warned of the problem in July.

Isaacs didn’t do well on Cipro. She suffered severe chest pain — “I thought I was having a heart attack” — and felt anxious and irritable.

Her personality changes have receded, she said. But occasional twinges of chest pain persist, along with a sense of weakness.

She does worry about urinary tract infections; she has seen the delirium they can cause in her older clients. But she may approach the issue differently next time. 

“I probably would take something,” she said. “But I won’t take Cipro.”