Antibiotics for urinary tract infections in older people: When you need them—and when you don’t


Released October 29, 2014

Antibiotics are medicines that can kill bacteria. Doctors often use antibiotics to treat urinary tract infections (UTIs). The main symptoms of UTIs are:

  • A burning feeling when you urinate.
  • A strong urge to urinate often.

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

 

Antibiotics usually don’t 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 doctors 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 don’t need another test to find out if you are cured.

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

 

Antibiotics have side effects.

Antibiotics can have side effects, such as fever, rash, diarrhea, nausea, vomiting, headache, tendon ruptures, and nerve damage.

 

Antibiotics can cause future problems.

Antibiotics can kill “friendly” germs in the body. This can lead to vaginal yeast infections. It can also lead to other infections, and severe diarrhea, hospitalization, and even death.

Also, antibiotics may help “drug resistant” bacteria grow. These bacteria are harder to kill. They cause illnesses that are harder to cure. Your doctor may have to try several antibiotics. This increases the risk of complications. The resistant bacteria can also be passed on to others. If you get an infection from resistant bacteria, you may need more doctor visits and medicines that cost more.

 

When should older people take antibiotics for a UTI?

If you have UTI symptoms, antibiotics can help.

  • The most common UTI symptoms are a painful, burning feeling when you urinate and a strong urge to “go” often.
  • Other UTI symptoms in older people may include fever, chills, or confusion. Along with these symptoms, there is usually pain on one side of the back below the ribs or discomfort in the lower abdomen. There may be a change in the way the urine looks or smells.

Some kinds of surgery can cause bleeding in the urinary tract—for example, prostate surgery and some procedures to remove kidney stones or bladder tumors. If you are going to have this surgery, you may need testing and treatment for bacteria in urine.

 


 

Steps to help you prevent urinary tract infections (UTIs):

Drink water. Most healthy people should drink six to eight glasses a day. A glass is about a cup or about 250 mL. If you have kidney failure, you should talk to your doctor about how much to drink.

Don’t hold it in. If urine stays in the bladder too long, infections are more likely. Try to urinate when you first feel the need.

Use good hygiene.

  • After a bowel movement, women should wipe from front to back, to avoid bringing bacteria into the urinary tract.
  • Both men and women should urinate after sex to flush out bacteria.

Use urinary catheters briefly, if at all.

  • Catheters are tubes put into the bladder to help with bladder control. They increase the risk of infection.
  • Many people in long-term care, such as nursing homes, have catheters. They can be helpful near the end of life when comfort is the main goal. In other cases, ask caregivers or the doctor to manage bladder-control problems without a catheter.
  • If you are in the hospital with a urinary catheter, ask your doctor to remove it as soon as possible. Even a few days with a catheter increases the risk of infection.