Tuesday, June 18, 2024

Long Term Antibiotics For Uti In The Elderly

Urinary Tract Infection Program

Long Term Chronic UTI Treatment: Chronic UTI Treatment, with Dr. Stewart Bundrick, Part 2

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.

What Are The Symptoms Of Urinary Tract Infection

Classic symptoms of UTI include:

  • Frequent and urgent need to urinate

  • Bladder incontinence

  • Social withdrawal

  • The symptoms of UTI in older adults related to changes in mood, cognition, and behavior are well-documented, but they often mimic symptoms of other conditions like dementia or stroke. This coupled with the fact that the elderly may not be able to tell you when they are experiencing classic symptoms of UTI make it important for their loved ones and caregivers to take prompt action when an abrupt change in mood or behavior is observed. Medical professionals can test for UTI and can determine whether or not a bacterial or fungal infection is present in the urinary tract, or if the changes are the result of some other condition. Tests for UTI are usually performed through urinalysis.

    The good news is that if UTI is diagnosed early enough, treatments are usually easy and effective. Depending on the source of infection, antibiotics or antifungal medications are used with great success against UTI. Drinking plenty of fluids while taking the medication will also help flush the infection out of the urinary tract. It is important to take the antibiotic or antifungal medication exactly as it is prescribed, even after UTI symptoms go away. Taking all of the medication will help kill all of the infections. Centric Healthcares trained and caring professionals can help ensure that their clients take all medications as prescribed and drink appropriate amounts of fluids.

    Does Taking An Antibiotic After Sex Prevent Utis

    According to the American Academy of Family Physicians, having sex three or more times a week increases your risk for recurrent UTIs. Your risk is also increased if you use a diaphragm or spermicide products, regardless of the frequency of sexual activity. If you experience recurrent UTIs, changing your method of contraception should be the first thing you consider.

    If you continue to suffer from UTIs and they are getting in the way of living a normal life, taking a preventive antibiotic could be an option. Taking regular antibiotics is not a risk-free treatment though, so have a conversation with your provider about whether this is right for you. Taking an antibiotic before or after sex can prevent recurrent UTIs especially if UTIs repeatedly show up 24 hours after intercourse.

    During sex, bacteria can get into the urinary tract and cause infections. Antibiotics work by fighting these bacteria. E. coli is the most common bacteria that causes UTIs. Common antibiotics used to treat UTIs are nitrofurantoin, cephalexin, or trimethoprim/sulfamethoxazole .

    A clinical trial showed that only 2 out of 16 women who took TMP/SMX right after sex had recurrent UTIs compared to 9 out of 11 women who had a sugar pill. The results were the same regardless of how often the women had sex.

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    Treatments For Recurrent Uti In Elderly Patients

    Is there a role for suppressive antibiotic therapy in geriatric patients with recurrent urinary tract infections ? Is there any scientific evidence in support of cranberry supplements ? ELIZABETH HALL, MSN, APRN, FNP-C, Dayton, Ohio

    Cranberry juice inhibits adherence of uropathogens to uroepithelial cells, thus preventing pathogenic colonization. Clinical research shows that consuming cranberry juice cocktail 300 ml daily or cranberry capsules 400 mg b.i.d. daily for six months significantly reduced UTIs in elderly women compared with placebo . There is no evidence that cranberry juice or tablets are effective for treating an acute infection.

    Suppression antibiotic therapy in the geriatric population is another concern. Prophylaxis has been advocated for women who experience two or more symptomatic UTIs within six months or three or more in 12 months. The choice of antibiotic should be based on susceptibility patterns causing the patients previous UTI.

    Eradication of a previous UTI must be assured by obtaining a negative culture one to two weeks after treatment. Numerous studies have demonstrated that continuous prophylaxis decreases recurrence by up to 95% compared with placebo. However, antibiotic resistance is always a concern, as is the risk of the development of Clostridium difficile diarrhea.

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    Institutionalized Older Adults & Catheterized Patients

    A new stepwise approach to diagnosing a urinary tract infection and ...

    Similar to other populations, the diagnosis of symptomatic UTI in nursing home residents requires the presence of genitourinary symptoms in the setting of a positive urine culture. In older adults who are cognitively intact, the diagnosis of symptomatic UTI is relatively straightforward. However, nursing home residents often suffer from significant cognitive deficits, impairing their ability to communicate, and chronic genitourinary symptoms , which make the diagnosis of symptomatic UTI in this group particularly challenging. Furthermore, when infected, nursing home residents are more likely to present with nonspecific symptoms, such as anorexia, confusion and a decline in functional status fever may be absent or diminished . In the setting of atypical symptoms, providers are often faced with the challenge of differentiating a symptomatic UTI from other infections or medical conditions. The high prevalence of bacteriuria plus pyuria in this population often leads to the diagnosis of UTI. Although bacteriuria plus pyuria is necessary for diagnosis of a laboratory-confirmed UTI, alone it is not sufficient for making the diagnosis of symptomatic UTI. To date, universally accepted criteria for diagnosing UTI in this population do not exist, making it difficult for providers to distinguish a symptomatic UTI from other conditions in the presence of new nonspecific symptoms.

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    Q: What Are Fluoroquinolones

    A: Fluoroquinolones are a relatively new class of antibiotics of which Cipro is probably the best-known. They were first introduced in the 1990s and are typically used for more intense bacterial infections such as anthrax . They are not generally recommended for uncomplicated urinary tract infections. But may be prescribed in certain cases. Fluoroquinolones are known to have potentially serious side effects, including nerve damage and more .

    How To Prevent Urinary Tract Infections In The Elderly

    With a proper understanding of UTI, its potential causes, and risk factors there are some simple things that all of us can do to help prevent infections in our urinary tracts. Some of the most practical preventive behaviors are:

  • Drink plenty of fluids daily, especially water

  • Urinate as soon as the urge hits

  • Urinate immediately after sexual intercourse

  • Wipe from front to back after a bowel movement

  • Avoid bladder irritants like caffeine and alcohol

  • Avoid irritating feminine hygiene products like deodorants, douches, and powders

  • Drink cranberry juice

  • In addition to the suggestions listed above, here are some preventive behaviors specifically for avoiding UTI in seniors:

  • Establish and follow a regular urination schedule, using alarms if necessary

  • Take enough time to empty the bladder completely when urinating

  • Wear cotton underwear and loose-fitting pants

  • Change incontinence pads and underwear immediately after they are soiled

  • The prevention of UTI in older adults boils down to two words: better care. Remember, as people age, they sometimes lose the ability to care for themselves in ways that we all take for granted when we are younger. This makes it essential for loved ones and professional caregivers to be vigilant, look for unmet care needs, and respectfully provide that care when necessary.

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    Characteristics Of The Study Population

    In the current 5 year retrospective cross-sectional study, 460 participants were included in which women 279 were in majority as compared with men 181 with a mean age of 72 ± 4 years. Most of the study participants 342 were in the age range of 6575 years of age and 118 were above 75 years. Majority of the included population was married 256 , Chinese 271 , non-smokers 312 , and non-alcoholic 318 . Detailed association between the sociodemographic variables with the treatment outcome parameters among the study population infected with UTIs is presented in Table 1.

    Why Your Uti Test Results May Be Negative Despite Symptoms

    Out of hospital management of UTIs in elderly patients

    Now that weve explained a bit more about why your recurrent UTIs may in fact be one, embedded UTI, lets take a look at UTI testing.

    Have you ever had UTI symptoms, felt quite sure that you have a UTI, but your test has come back negative? This is incredibly common not to mention frustrating. And your hunch is likely right: If you are experiencing symptoms, its very possible you have a UTI.

    There are a few reasons why your UTI test result might be negative:

  • Urine is not sterile

    It has been found that the bladder has its own unique microbiome with hundreds of different bacteria. So a urine sample that may be dismissed as being contaminated with foreign bacteria, may in fact contain bacteria that are an important part of the puzzle.

  • The pathogens causing your symptoms may not be in your sample

    Standard UTI test methods focus on free-floating pathogens. Embedded biofilm infections attached to the bladder wall are not free-floating and less likely to pass out via your urine sample. Its also possible your urine sample is too diluted, e.g. due to over-hydrating.

  • UTIs can be caused by multiple pathogens

    As mentioned earlier, a UTI can be caused by multiple infection-causing pathogens. The 1950s test only looks for a single pathogen. If more than one are found, it may presume the urine sample was contaminated.

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    Q: How Is A Single Dose Antibiotic Taken

    A: Fosfomycin comes in powder form. You typically mix it with a half-glass of water and drink it straight away. Whether you take it with or without food makes no difference. Whether you take standard antibiotics or single dose antibiotics you will likely feel better in a few days. The difference is that you will not need to remember to take antibiotics twice a day for 10 days. This increases compliance and reduces the chance of recurrence.

    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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    Q: What Is A Single Dose Antibiotic

    A: Single dose antibiotic treatments have emerged in response to the dangers of overprescribed and improperly used standard antibiotics. Instead of taking an antibiotic twice a day for 10 days, the patient is given a single, large antibiotic dose that undermines the activity of the bacteria and brings an immediate halt to the infection. Many doctors are now transitioning to single dose antibiotic treatment for uncomplicated UTIs .

    Characteristics Of Included Studies

    Urinary Tract Infection and Asymptomatic Bacteriuria in Older Adults ...

    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.

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    Which Antibiotic Should Be Used To Treat A Uti

    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.

    What Issues Are There With Bladder Instillations

    • There are no large randomised control studies to demonstrate long term efficacy for the management of chronic urinary tract infections using bladder instillations.
    • Studies relating to patients without neurogenic bladder problems or those who have undergone renal surgery focus on the replenishment of the GAG layer in the bladder. The European Urological Association noted:A recent review of 27 clinical studies concluded that large-scale trials are urgently needed to assess the benefit of this type of therapy. Therefore, no general recommendation is possible at this stage. This Cochrane Review published in 2016 confirms these findings.
    • There are no standardised treatment regimes instillations in trials have been offered daily for a week, every third day or once a week
    • Antibiotics used in instillations are often generic medications thus no pharmaceutical manufacturing company has carried out its own trials on generic antibiotics used in instillations. This means that clinicians often have to develop their own treatment regimes you may come across the words rescue instills which can include not only an antibiotic but also a steroid and gag layer replenishment agent.
    • It is invasive which makes it logistically awkward and adds to the treatment expense offered to patients by local clinical commissioning groups and hospitals
    • The usage of catheters may introduce further bacteria into an infected bladder

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    Antibiotics And Persister Cells

    One of the key issues in the treatment of a chronic UTI is the known problem of persister cells. These are infected bacterial cells which lie dormant deep within the bladder wall. Whilst the antibiotic options covered above will target those bacterial cells which are either actively dividing on the wall of the bladder, are newly introduced into the bladder via the urethra or have been shed into the urine by the immune system response, ongoing treatment options must take into account the problem of persister cells.

    Flares often occur when dormant bacteria are stimulated, break out of their own cells and seek new cells to colonise. The immune system reacts accordingly causing an increase in symptoms. It is critical that ongoing antibiotic coverage is available during these periods. Discuss with your chronic UTI specialist the most appropriate management options to suit you.

    Who Is Affected By Utis And How Are They Treated

    WGA- Elderly UTI Symptoms

    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.

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    Hunners Ulcers Harbor Bacteria

    Melissa We do have some other questions about long-term antibiotics but I wanted to go back briefly to the infection embedded in the bladder wall. I wanted to ask if that is what you believe is the cause for the ulcers that are sometimes referred to as Hunners lesions, and if so, can those then be treated in the same way?

    Ruth: Well Hunners ulcers remind me of stomach ulcers. In the stomach you have H. pylori as a causative agent. It gets embedded in the lining and if it goes for a long time untreated the lining ulcerates. I think its the same process in the bladder wall.

    Hunners ulcers are infection and I have had several patients that we have successfully healed by treating the bacteria that are responsible for damaging the bladder wall in that location to that extent.

    Now some people have procedures in which they go in with a laser and they actually treat that area and that resolves a lot of the pain issues a whole lot faster. So that is an option but I think thats only a temporary solution because if theres still a lot of infection throughout the bladder wall, the propensity is going to be to form more ulcers down the road if you fail to treat the infections that are responsible in the first place.

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