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Background and Objective <p>Fluoroquinolones are among the most frequently prescribed antibiotics in older adults. Age-related pharmacokinetic (PK) changes can affect treatment efficacy and increase the risk of adverse drug reactions. This systematic review provides a comprehensive overview of the current knowledge on the PK and PK/pharmacodynamic (PD) target attainment of fluoroquinolones in older adults to inform strategies for personalised fluoroquinolone therapy.</p> Methods <p>A comprehensive search of the Medline, Embase, Web of Science and Scopus databases was conducted. Relevant articles published before 1 December 2024 were included when they contained data on the PK of fluoroquinolones in older adults (median age ≥ 65 years). Extracted information included PK parameters, significant covariates influencing PK parameters, PK/PD target attainment rates and dosing recommendations. The ClinPK Statement checklist was used for quality grading.</p> Results <p>Fifty-five articles were included in this review, encompassing a total of 1542 non-critically ill older adults and 585 younger controls. Eight articles (14.5%) identified covariates with a significant effect on PK parameters. Most of these covariates (66.7%) were indicators of renal function. PK/PD target attainment was assessed in 30.9%, and dosing recommendations were provided in 61.8% of all included PK studies. Studies had an average quality score of 65.9% (standard deviation, SD ± 12.3%).</p> Conclusions <p>High-quality PK studies on fluoroquinolones in older adults remain sparse. While a substantial amount of the included articles provided dosing recommendations, only a minority did so on the basis of PK/PD target attainment data. The limited application of advanced PK/PD modeling and simulation approaches hampers the development of evidence-based, individualised fluoroquinolone dosing strategies in older adults.</p> Trial Registration <p>Prospectively registered in PROSPERO. Trial registration number: CRD42023480126. Registration date: 17/11/2023.</p>

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Pharmacokinetics and Target Attainment of Fluoroquinolones in Older Adults: A Systematic Review

  • 期刊论文

  • 发表日期：

    2025年12月5日

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  • Arnaud De Clercq,
  • Jeroen Vervalcke,
  • Cristina De Petter,
  • Stef De Ryck,
  • Tania Desmet,
  • Peter De Paepe,
  • Mirko Petrovic,
  • Pieter A. De Cock

摘要

Background and Objective

Fluoroquinolones are among the most frequently prescribed antibiotics in older adults. Age-related pharmacokinetic (PK) changes can affect treatment efficacy and increase the risk of adverse drug reactions. This systematic review provides a comprehensive overview of the current knowledge on the PK and PK/pharmacodynamic (PD) target attainment of fluoroquinolones in older adults to inform strategies for personalised fluoroquinolone therapy.

Methods

A comprehensive search of the Medline, Embase, Web of Science and Scopus databases was conducted. Relevant articles published before 1 December 2024 were included when they contained data on the PK of fluoroquinolones in older adults (median age ≥ 65 years). Extracted information included PK parameters, significant covariates influencing PK parameters, PK/PD target attainment rates and dosing recommendations. The ClinPK Statement checklist was used for quality grading.

Results

Fifty-five articles were included in this review, encompassing a total of 1542 non-critically ill older adults and 585 younger controls. Eight articles (14.5%) identified covariates with a significant effect on PK parameters. Most of these covariates (66.7%) were indicators of renal function. PK/PD target attainment was assessed in 30.9%, and dosing recommendations were provided in 61.8% of all included PK studies. Studies had an average quality score of 65.9% (standard deviation, SD ± 12.3%).

Conclusions

High-quality PK studies on fluoroquinolones in older adults remain sparse. While a substantial amount of the included articles provided dosing recommendations, only a minority did so on the basis of PK/PD target attainment data. The limited application of advanced PK/PD modeling and simulation approaches hampers the development of evidence-based, individualised fluoroquinolone dosing strategies in older adults.

Trial Registration

Prospectively registered in PROSPERO. Trial registration number: CRD42023480126. Registration date: 17/11/2023.