Prescription antibiotics almost always completely useless for UTIs in older women, study finds

A recently published research paper revealed that prescription antibiotics may not be as effective as previously thought, and may even cause more harm than good in older patients with urinary tract infection. Research author Dr. Thomas E. Finucane of the Johns Hopkins Geriatrics Center at Johns Hopkins in Baltimore noted that antibiotic treatment may often be avoided as UTI remains to be a vague and overused diagnosis that may apply to asymptomatic older patients who may also show ambiguous signs including urinary bacteria, falls, and confusion.

Dr. Finucane also stressed that the scientific community has already gained better understanding of the types of bacteria, viruses, and other microorganisms that are present in the human body. According to the health expert, it is common knowledge that the human urine hosts various viruses and bacteria, and that certain microorganisms are actually beneficial to the body’s overall health. The geriatrics specialist also emphasized that antibiotic therapy may even be detrimental to the elderly population.

However, Dr. Finucane said certain groups may still benefit from antibiotic treatment for UTI. These include pregnant women, people about to have bladder or urinary tract surgery, individuals with invasive bacterial diseases such as kidney infections, and people in need of immediate antibiotic treatment. The health expert also cited microbiome studies indicating that the treatment might be more harmful than previously estimated. However, the doctor urged people with UTI and those undergoing antibiotic treatment to discuss these concerns with their health care providers before changing their care plan.

“Significant bacteriuria and urinary symptoms are common, often occur together, and generally resolve spontaneously. Neither is strongly linked to serious urinary tract disease or to likelihood of benefit from antibiotic treatment, with the limited exceptions discussed above…Nonetheless, treatment for “UTI” is common for individuals with symptoms, bacteriuria, or both and for those with delirium and standard bacteriuria…It is likely that careful discussion of risks and benefits would reduce antibiotic overuse. 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. Public education would also help because some individuals and their families resolutely expect antibiotic treatment on hearing the diagnosis of “UTI”,” Dr. Finucane wrote in the Journal of the American Geriatrics Society.

Study: Antibiotic treatment falls short on UTI efficacy

A previous study demonstrated that antibiotic treatment may not show utmost efficacy in relieving UTI in older patients. Published in the Canadian Medical Association Journal, researchers revealed that the antibiotic drug nitrofurantoin was not the most effective UTI treatment, and even spurred unwanted side effects in older patients. To carry out the study, a team of researchers from the Western University in London, Ontario examined 10,000 older women with low kidney function and more than 180,000 women with normal kidney function.

The study also concluded that nitrofurantoin fell short in relieving UTI in patients compared with other treatments. The study showed that nitrofurantoin raised the risk of repeat UTI treatment with other drugs. Patients who took the drug were also more likely to be hospitalized for UTI. In addition more than 25 percent of patients exhibited reduced kidney function. Bladder cancer was the most common complaint among patients, the researchers said. (Related: Here’s how you can combat UTI the natural way)

“In our setting, nitrofurantoin was the most commonly prescribed antibiotic for a urinary tract infection in older women irrespective of their kidney function. These patients had more treatment failures with nitrofurantoin compared with other antibiotics such as ciprofloxacin. However, this was evident regardless of a patient’s level of kidney function,” lead researcher Dr. Amit Gargwuoted said in HealthDay.com.

Sources include:

ScienceDaily.com

OnlineLibrary.Wiley.com

Consumer.HealthDay.com

CMAJ.ca