For older adults with a urinary tract infection, antibiotic treatment should begin immediately to prevent serious complications, a new British study finds.
Delaying or withholding antibiotics in this age group can increase the risk of bloodstream infection (sepsis) and death, researchers reported recently in the BMJ.
The findings suggest that doctors should “consider early prescription of antibiotics for this vulnerable group of older adults, in view of their increased susceptibility to sepsis following UTI and despite a growing pressure to reduce inappropriate antibiotic use,” Paul Aylin and colleagues said in a journal news release. Aylin is a professor of epidemiology and public health at Imperial College London.
UTI is the most common bacterial infection in older patients. But concerns about antibiotic resistance have led to reductions in antibiotic use in England, the study authors noted.
For the study, the researchers analyzed data on more than 300,000 urinary tract infections among more than 150,000 patients aged 65 and older, between 2007 and 2015.
Of those patients, 87 percent were prescribed antibiotics on the day of diagnosis, 6 percent received a prescription within seven days and 7 percent did not take antibiotics, according to the report.
The patients were tracked for 60 days after their diagnosis. After accounting for other factors, the investigators found that sepsis and death rates were much higher among patients with no antibiotics or delayed prescriptions, compared with those who received immediate prescriptions.
On average, for every 37 patients not given antibiotics and for every 51 patients with delayed antibiotic treatment, one case of sepsis would occur that would not have occurred with immediate antibiotic treatment, the study authors said.
However, because this was an observational study, it cannot prove cause and effect.
The researchers also found that hospital admission rates were 27 percent among patients with no and delayed prescriptions, compared with 15 percent among those with immediate prescriptions.
Older men, especially those over 85, and those living in poorer areas had the highest risk of problems from no prescriptions or treatment delays, the findings showed.
Writing in an accompanying journal editorial, Alastair Hay, of the University of Bristol in England, suggested that further research is needed “to establish whether treatment should be initiated with a broad- or a narrow-spectrum antibiotic, and to identify those in whom delaying treatment (while awaiting test results) is safe.”