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Antibiotic For Bladder Infection In Elderly

What Happens If A Uti Goes Untreated For An Older Person

Antibiotic Awareness: Urinary Tract Infection (UTI), Cystitis or Bladder Infection

UTI infections that go untreated can spread from your bladder to your kidneys and beyond. Especially in older adults or anyone with a lowered immune system, treating an infection earlier can keep it from spreading and overwhelming your system.

An infection that goes untreated can lead to , a serious form of infection. Dr. Slopnick says fear of sepsis is what causes some people to worry about asymptomatic bacteriuria. If you have a UTI, youll almost certainly show symptoms long before the infection spreads or sepsis sets in.

What If I Have Frequent Recurring Utis

Within a year of havig a UTI infection, roughy one-quarter to one-half of women will have another UTI. For these women antibiotic prophylaxis may be recommended by her health care provider. With a recurrent course of UTIs, a urine culture or imaging tests may be required for further analysis.

For recurrent UTIs, there are several antibiotic options for prevention:

  • A shorter course of antibiotics at the first sign of UTI symptoms a prescription may be given to you to keep at home.
  • A longer course of low-dose antibiotic therapy.
  • Take a single dose of an antibiotic after sexual intercourse.

The choice of antibiotic is based on previous UTIs, effectiveness, and patient-specific factors such as allergies and cost. Antibiotics commonly used for recurrent UTIs can include sulfamethoxazole-trimethoprim, nitrofurantoin, cefaclor, or cephalexin.

In postmenopausal women with vaginal dryness that may be leading to recurrent UTIs, vaginal estrogen may be an effective treatment. Treatment options your doctor might recommend include: Estring, Vagifem , or vaginal estrogen creams .

The Evidence: Diagnosis Management And Prevention

We searched Ovid for English-language human studies conducted among adults aged 65 years and older and published in peer-reviewed journals from 1946 to November 20, 2013. We focused on community-dwelling older adults. Search terms included UTI, asymptomatic bacteriuria, risk factors and UTI, community-onset UTI, functional decline and UTI, delirium and UTI, dehydration and UTI, diagnosis and UTI, diet and drug therapy and UTI, prevention and UTI, and urine tests and UTI. We also searched for recently published Cochrane reviews regarding treatment and prevention of UTI in community-dwelling older adults. The recommendations that follow are based on evaluation of the existing evidence.

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Why Are They Not Helpful

Antibiotics are medicines that can kill bacteria. Health care providers often use antibiotics to treat urinary tract infections .

The main symptom of a UTI is a burning feeling when you urinate.

However, many older people get UTI treatment even though they do not have these symptoms. This can do more harm than good. Heres why:

Antibiotics usually dont help when there are no UTI symptoms.

Older people often have some bacteria in their urine. This does not mean they have a UTI. But health care providers may find the bacteria in a routine test and give antibiotics anyway.

The antibiotic does not help these patients.

  • It does not prevent UTIs.
  • It does not help bladder control.
  • It does not help memory problems or balance.

Most older people should not be tested or treated for a UTI unless they have UTI symptoms. And if you do have a UTI and get treated, you usually dont need another test to find out if you are cured. You should also not be tested just in case there is a UTI.

You should only get tested or treated if UTI symptoms come back.

Uti In The Elderly: Signs Symptoms And Treatments

ASK DIS: Urinary Tract Infection: Antibiotics in Adults

Urinary tract infections arent just a nuisance in the senior populationthey can cause serious health problems. A UTI occurs when bacteria in the urethra, bladder or kidneys multiplies in the urine. Left untreated, a UTI can lead to acute or chronic kidney infections, which could permanently damage these vital organs and even lead to kidney failure. UTIs are also a leading cause of , an extreme and potentially life-threatening response to an infection.

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Residential Aged Care Setting

A 2018 Australian national aged care antimicrobial prescribing survey indicated that UTI was the second most common clinical indication for antimicrobial prescription. Moreover, cystitis has been consistently the most frequently reported known indication for prescriptions for prophylaxis in 2016â2018. Encouragingly, prescriptions for ASB were reported to have fallen from 46% in 2016 to 2.1% in 2018.

For people residing in aged care facilities, recommendations for the initiation of antibiotics for UTI have been established., , ASB should not be treated with antimicrobial therapy, for either treatment or prophylaxis, as antibiotic therapy does not reduce the rate of complications associated with this condition, and has been shown to paradoxically increase the risk of subsequent UTI., , Additionally, unnecessary antimicrobial treatment is associated with the development and progression of antimicrobial resistance, adverse drug events, such as liver function derangement to beta-lactam antibiotics and the development of Clostridiodes difficile infection., –

Implications For Research And Practice

Based on the data we analysed, a pragmatic approach is required when considering prescribing long-term antibiotics in older patients with recurrent UTI. Although long-term antibiotics may reduce the risk of UTI recurrence in women, this benefit diminishes on cessation of treatment. Little is known about optimal prophylaxis period, long-term effects on health, risk of antibiotic resistant infections, effect in older men, effect in frail care home residents or impact on important patient-centred outcomes. These unknowns must be balanced against benefits and patient preferences.

Future research efforts on recurrent UTI should focus on improving the design and reporting of trials and developing a core set of outcomes to allow better synthesis of trial data. Antibiotic prophylaxis should be compared with non-antibiotic prophylaxis with some evidence of efficacy rather than those with little or poor evidence of efficacy. Researchers should address unanswered questions regarding long-term effects, duration of use, adverse effects and antibiotic resistance.

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Characteristics Of Included Studies

There were four large retrospective cross-sectional studies, and among the remaining studies the number of patients in each study varied considerably from small community samples of 9 to larger hospital samples of 710 . The majority of the studies identified were cross-sectional in design. Approximately half of the studies had an entirely elderly population65years , with the other half of studies having populations deemed to be representative of an elderly population by median or mean age65years . In the two remaining studies, one conducted in a nursing home and the other in a psychogeriatric unit, the demographics of the patient sample were not provided. They were believed to be representative of an elderly population by their care setting. The proportion of participants with urinary catheters was unclear in the majority of included studies . In the remaining studies, urinary catheter rates were high, 3751% , low 1.85.5% and none . The majority of the studies were conducted in a hospital setting , followed by nursing homes and community settings . Interestingly, only two of the included studies had the explicit aim of exploring the association between confusion and UTI however, ten studies did partially explore this association.

How Common Are Urine Infections

Out of hospital management of UTIs in elderly patients

Urine infections are much more common in women. This is because in women the urethra – the tube from the bladder that passes out urine – is shorter. Also it opens nearer the back passage than in men. Half of all women will have a urine infection that needs treating in their lifetime.

Urine infections are less common in men. They are very uncommon in young and middle-aged men. They are more common in older men. They are more likely to occur in men who have to use a catheter. A catheter is a thin, flexible, hollow tube used to drain urine. Older men are more likely to need a catheter because of prostate problems, which become more common with age.

Urine infections tend to become more common as you get older.

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How Common Is Asymptomatic Bacteriuria

Asymptomatic bacteriuria is more common in older adults than many people including practicing clinicians may realize:

  • In women aged 80 or older, 20% or more may have this condition.
  • In healthy men aged 75 or older, 6-15% have been found to have bacteria with no UTI symptoms.
  • Studies of nursing home residents have found that up to 50% may have asymptomatic bacteriuria.

This condition also affects 2-7% of premenopausal women, and is more common in people with diabetes.

Asymptomatic bacteriuria becomes more common as people get older, in part because it is related to changes in the immune system, which tends to become less vigorous as people age or become frailer.

Studies have found that in older adults, asymptomatic bacteriuria does sometimes go away on its own, but it also often comes back or persists.

Urine Infection In Older People

In this series

If you have a urine infection, you have germs in your bladder, kidneys or the tubes of your urinary system. Urine infections are more common in older people, and there is more likely to be an underlying cause.

In this article

Urine Infection in Older People

In this article

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Urinary Tract Infection Program

We have developed the Urinary Tract Infection program to respond to concerns about the overuse of antibiotics for presumed UTIs in residents in long-term care homes and the associated antibiotic-related harms. The UTI program supports long-term care homes to improve the management of UTIs for non-catheterized residents in their homes and helps them implement the organizational and individual practice changes required.

PHO has helped over 100 long-term care homes to implement the UTI Program. PHO now offers a new type of support for the UTI Program that is flexible and tailored.

How does it work?Please take a look at the UTI web page and at the five practice changes for details. Our coaches are here to support the leads from your home through one-on-one phone calls, which will focus on everything that your home needs to implement a successful program.

How do we get in touch?Please email if you would like to learn more about the UTI program or are interested in receiving coaching support.

Utis In The Geriatric Population: Challenges For Clinicians

ASK DIS: Urinary Tract Infection: Antibiotics in Adults

Kenneth R. Cohen, PharmD, PhDAssociate Professor of Pharmacy and Health OutcomesTouro College of Pharmacy

Jerry Frank, MD, Fellow, AAFPClinical Assistant ProfessorSUNY Stony Brook School of MedicineDepartment of Family Medicine

Parker Jewish Institute of Health Care and RehabilitationNew Hyde Park, New York

US Pharm. 2011 36:46-54.

The challenge of developing guidelines for the diagnosis, management, treatment, and prevention of urinary tract infections is a daunting one. The condition runs through diverse populations of the elderly, from the walking well to the chronically ill. Each population has unique characteristics and requires a tailored approach to diagnosis and treatment.

In this article, the discussion of UTIs has been structured according to walking-well, chronically ill, and institutionalized elderly patients in order to better elucidate the issues associated with each population.

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Comparison With Existing Literature

This study comprised a large sample size population, assessing the real life care management, including no antibiotics and deferred antibiotics, as well as the outcomes and care pathway of older adults with a diagnosis of UTI in primary care. Limited evidence is available to support the choice of no antibiotics or of deferred antibiotics for the management of UTI in primary care, as ethical concerns have prevented placebo controlled studies for UTI.31

A systematic review of randomised controlled trials showed that antibiotic treatment is more effective at achieving faster symptom relief, microbiological clearance, and lower reinfection rates than placebo for uncomplicated cystitis in women aged 15 to 84 years.32 However, potential unintended adverse events have not been explored as a large sample size would be needed to capture these rare serious adverse events. Another randomised controlled trial, which evaluated the efficacy of initial symptomatic treatment with ibuprofen versus immediate antibiotic treatment in uncomplicated UTI for women younger than 65 years has shown an increase in the total burden of symptoms and pyelonephritis cases in the ibuprofen arm.33

There is also a major concern about the risk of C difficile infection in elderly people associated with antibiotic use, which also includes trimethoprim.3940

Data Extraction And Quality Assessment

One reviewer extracted study characteristics and outcome data from included trials. We contacted two authors for subgroup data on postmenopausal women. One author replied and provided relevant outcome data. Two reviewers independently assessed the risk of bias of the included studies using the Cochrane Collaborations risk of bias tool. Disagreements were resolved through discussion. We used RevMan V.5.3 to meta-analyse the data and generate forest plots.

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What About Antibiotic Resistance

Resistance rates for antibiotics are always variable based on local patterns in the community and specific risk factors for patients, such as recent antibiotic use, hospital stay or travel. If you have taken an antibiotic in the last 3 months or traveled internationally, be sure to tell your doctor.

High rates of antibiotic resistance are being seen with both ampicillin and amoxicillin for cystitis , although amoxicillin/clavulanate may still be an option. Other oral treatments with reported increasing rates of resistance include sulfamethoxazole and trimethoprim and the fluoroquinolones. Resistance rates for the oral cephalosporins and amoxicillin/clavulanate are still usually less than 10 percent.

Always finish taking your entire course of antibiotic unless your doctor tells you to stop. Keep taking your antibiotic even if you feel better and you think you don’t need your antibiotic anymore.

If you stop your treatment early, your infection may return quickly and you can develop resistance to the antibiotic you were using previously. Your antibiotic may not work as well the next time you use it.

How To Take It

Mayo Clinic Minute: Treating Urinary Tract Infections

Swallow nitrofurantoin tablets and capsules whole. Do not chew or break them.

Theres a liquid nitrofurantoin for people who find it difficult to swallow tablets.

If youre taking nitrofurantoin as a liquid, itll usually be made up for you by your pharmacist. The medicine will come with a syringe or spoon to help you take the right amount. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give the right amount.

The dose of nitrofurantoin you need to take depends on whether its being used to treat or prevent a urinary tract infection, your age, and how bad the infection is.

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How To Feel Better

If your healthcare professional prescribes you antibiotics:

  • Take antibiotics exactly as your healthcare professional tells you.
  • Do not share your antibiotics with others.
  • Do not save antibiotics for later. Talk to your healthcare professional about safely discarding leftover antibiotics.

Drink plenty of water or other fluids. Your healthcare professional might also recommend medicine to help lessen the pain or discomfort. Talk with your healthcare professional if you have any questions about your antibiotics.

When To See A Health Care Providerand What To Expect

If you have any of the signs of a bladder problem or urinary tract infection, talk to your healthcare provider. Read advice on talking to your doctor about sensitive subjects, like bladder problems.

When you see your healthcare provider, he or she may perform the following tests to try to figure out what might be causing your bladder problem:

  • Give you a physical exam to look for any health issues that may cause a bladder problem. For women, the physical exam may include a pelvic exam. For men, the physical exam may include a prostate exam, which is usually done with a rectal exam.
  • Take a urine sample to check for a bladder infection.
  • Examine the inside of your bladder using a cystoscope, a long, thin tube that slides up into the bladder through the urethra. This is usually done by a urinary specialist.
  • Fill the bladder with warm fluid to check how much fluid your bladder can hold before leaking.
  • Check a bladder scan using ultrasound to see if you are fully emptying your bladder with each void.

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Who Is Affected By Utis And How Are They Treated

Women are more commonly affected by them than men. Around half of women will need treatment for at least one UTI during their lifetime.

If treated with the right antibiotics, UTIs normally cause no further problems and the infection soon passes. Though complications are uncommon, they can be serious and include kidney damage and blood poisoning, which can be fatal.

Which Antibiotic Should Be Used To Treat A Uti

ASK DIS: Urinary Tract Infection: Antibiotics in Adults

There are multiple types of antibiotics used to treat urinary tract infections . Different treatments may be recommended in different areas of the country based on regional patterns of antibiotic resistance.

Most patients with an uncomplicated UTI will begin treatment without any special diagnostic test, although a urinalysis may be performed by taking a urine sample. In a urinalysis, the chemical components of the urine are determined, and the doctor may look at urine color, clarity, and a view a sample under the microscope. A urine culture may be order, too, but is not always needed to start treatment. A urine culture can define the specific bacteria causing the UTI in more complicated cases or in the case of treatment failure.

Symptoms like burning and stinging while urinating will usually clear up in within one day after starting treatment. Be sure to finish your entire course of medication. If symptoms are still present after 2 to 3 days, contact your healthcare provider.

More extensive diagnostic procedures or imaging tests like an X-ray may be required if you continue to have frequent UTIs.

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