Home based care of the bedridden elderly with infectious diseases

Abstract

Combined antibiotic treatment with amikacin (200 mg/day) and minocycline (100 mg/day), which substantially have anti-bacterial action against methicillin-resistant Staphylococcus aureus (MRSA), was introduced as the first line therapy for infectious diseases of the bedridden elderly at home, and its effectiveness has been clinically evaluated in the tsunami disaster area. For the past three years, 113 cases out of 292 out-patients (ages；45〜105 years old, average 85 years old) caught bacterial infectious diseases, and total of 324 infectious events were treated with the combined therapy by 1〜2 weeks home visits. Respiratory tract infections including pneumonia (202 events, 62%) and urinary tract infections (105 events, 33%) were the most common while biliary tract and skin infections and enterocolitis were occasional causes. In the case of respiratory tract infections, the first line therapy (AMK + MINO) was successfully administered in 151 events but was changed in 51 events because of no apparent improvement of clinical symptoms (11 cases), the detection of drug-resistant bacterial pathogens (24 cases) or drug-induced allergy (1 case). The major clinical pathogens with the drug-resistant nature were MRSA (9 cases) and Pseudomonas aeruginosa (5 cases). Amikacin and minocycline accounted for 75% of the administered antibiotics in our out-patient clinic where no MRSA has been detected for more than 14 months to date. It is suggested that combined antibiotic treatment with amikacin and minocycline is a useful therapy for not only health care-associated pneumonia but also MRSA infection among elderly people at home.