Antibiotics Often Inappropriate for UTIs in Seniors

New research published ahead of print in the Journal of the American Geriatrics Society advises that urinary tract infections (UTIs) among elders often do not require antibiotics.  

In a special article, Thomas E Finucane, MD, John Hopkins Bayview Medical Center (Baltimore, MD), reasons that the common definition of “UTI” is too vague and overused, especially as researchers are beginning to understand more about the various kinds of bacteria, viruses, and other microorganisms living in the body (doi:10.1111/jgs.14907).

Indeed, Dr Finucane explains how, with our growing knowledge from microbiome studies examining the benefits and harms caused by billions of organisms in the body, UTI treatment with antibiotics may actually be more harmful to patients—especially older adults—than doctors think.
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Based on his assessments of the current research, Dr Finucane suggests that better antibiotic treatment decisions will only be made after improved understanding of “how pathogenicity arises within microbial communities.”

He also comments that increased discussion and awareness of the problematic definition and connotations of UTI may help in advancing care practices. he says “urinary tract dysbiosis” may be a more helpful term to use in the context of studying the relationships of microbiomes, antibiotic treatment, and aging.

In terms of public education, he thinks that “meaningful informed-consent discussions” on antibiotic treatment may reduce overtreatment of bacteriuria. Specifically for those in nursing facility settings, he wrote, “Decision-making with or on behalf of long-term care residents with bacteriuria who develop delirium should also include disclosure of the high prevalence of asymptomatic bacteriuria in stable residents, the corresponding likelihood that the bacteriuria is coincidental, lack of evidence of benefit from treatment, risks imparted by treatment, and consistent expert advice counselling against treatment.”—Amanda Del Signore