Antibiotic treatment in patients with altered pathophysiological pathways.

The pharmacokinetics of antibiotics are reviewed under particular physiological (senescence) and pathological (renal failure, liver failure) conditions. As regards the antibiotic management in the elderly, the main problems are related to the "immunosenescence" and to kinetic modifications, occurring even in the absence of an evident renal impairment. If manifest renal failure is present, the main issue is the correct dosage, and a careful consideration of the interest of the patient when they have to undergo hemodialysis. In cases of liver failure, a number of factors impairing the kinetics of antibiotics are discussed, underlining how these are too often underestimated in therapeutical approaches. The paper is focused on the behavior of new molecules, with particular regard to Teicoplanin, Carbapenems and Fluoroquinolones.