Antibiotics May Not Benefit Older Adults With UTIs

Most people, especially older adults, may be better off without antibiotic treatment for urinary tract infections (UTIs), according to a new literature review.

Older adults showing symptoms of delirium and bacteriuria are commonly treated with antibiotics. However, there is no evidence to support this practice, and experts actually oppose it, according to the researchers.
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In a new review article, 5 randomized placebo-controlled trials indicated that patients with acute dysuria and significant bacteriuria who received antibiotics experienced symptom improvement that was only modestly faster than those who received the placebo. Also, antibiotics did not benefit older people with bacteriuria or other vague symptoms of UTI.

Although the review found that antibiotics may be harmful to older patients, some patient populations may see a benefit, including:

  • Those who become sick enough to require urgent antibiotic treatment, regardless of urine test results.
  • Those with invasive bacterial diseases, especially kidney infections.
  • Women who are pregnant.
  • Those who are about to have bladder or urinary tract surgery.

“In current practice, ‘I think this patient has a UTI’ often means, ‘I want to give this patient antibiotics,” the researchers said. “Clinicians considering intervention should not ask whether the individual has a real ‘UTI’ but should ask instead whether there is evidence that antibiotic treatment directed at standard bacteriuria is more likely to benefit than harm this individual. Microbiome studies suggest that treatment is even less beneficial and more harmful than is already believed. Clinicians have a major opportunity to improve care and public health.”

—Christina Vogt

Reference:

Finucane, TE. “Urinary tract infection”—requiem for a heavyweight. J Am Geriatr Soc. Published online May 19, 2017. doi:10.1111/jgs.14907.