Researchers from the Johns Hopkins Geriatric Center, Baltimore, MD, reported that for older patients, antibiotic therapy may not always be the right approach to treating urinary tract infections (UTI). Findings from the study were published in the Journal of the American Geriatrics Society.

For older adults who are asymptomatic but have bacteriuria and are also experiencing confusion, falls, or “other vague signs” (eg, changes in odor or color of urine), the diagnosis of “UTI” is often applied, though in most of these cases antibiotics may not benefit these patients.

In their paper, the authors noted that “healthy urinary tracts host a ubiquitous, complex microbial community” and that the presence of these microorganisms are often beneficial to overall well-being. Moreover, antibiotic treatment, in some cases, may be harmful especially for older adults. 

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While not all UTIs may need antibiotics, treatment is still beneficial for some patient groups. These include: 

  • Patients sick enough to require urgent antibiotic treatment regardless of findings in the urine
  • Patients with invasive bacterial diseases, especially renal infections
  • Pregnant women and patients about to undergo bladder or urinary tract surgery

“It is likely that public education and meaningful informed-consent discussions about antibiotic treatment of bacteriuria, emphasizing potential harms and uncertain benefits, would reduce overtreatment,” stated the authors, “Emphasizing the microbiome’s significance and using the term “urinary tract dysbiosis” instead of “UTI” might also help.”

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