When is a Bladder Infection Not a Bladder Infection?

One of the ways in which we can help to keep the older adults in our community healthy is by promoting the sensible use of antibiotics.

Older adults tend to take a lot of regular, daily medications, and adding antibiotics into this mix can put the older adult at risk of drug interactions, increased medication costs, risks of antibiotic side effects like diarrhea, and increase the risk of antibiotic resistance. (Antibiotic resistance causes infections that are harder to treat, meaning that people are sick for longer, and that there is an increased risk that the infection will spread to others).

One of the more common reasons for older adults to be prescribed antibiotics is for a urinary tract infection or UTI. Physicians can use tests called urinalysis or urine culture to find a UTI. Sometimes these tests will show the presence of bacteria in the urine, leading to the decision to start an antibiotic to kill the bacteria. It is important to note, however, that a positive test for bacteria in the urine does NOT necessarily mean that an infection is present.

But how can that be? Doesn’t finding bacteria in a urine test mean that there is an infection? Not all the time. The important thing to note is that among older adults, it is fairly common to find bacteria in the urine WITHOUT any signs or symptoms of a UTI. This combination of bacteria in the urine without any symptoms is called “asymptomatic bacteriuria”.

Although many people think that taking antibiotics to kill these bacteria in the urine would be a good idea, even without having any symptoms, that thinking is wrong. Except in rare circumstances, routine screening and treatments are NOT recommended for asymptomatic bacteriuria, and treating asymptomatic bacteriuria with antibiotics does NOT reduce the risk of an actual UTI developing later on.

All that an antibiotic treatment can be expected to achieve in these cases is to increase the risk of adverse effects and antimicrobial resistance.

In order to avoid potentially taking unnecessary antibiotics, older adults should only seek testing and treatment for UTI if they are experiencing pain on urination, tenderness in the flank or lower abdomen area, fever or chills, increasing urgency or frequency of bathroom visits, new incontinence, or blood in the urine.

It is difficult to ignore a positive test result for bacteria in the urine, but knowing that this can be common among older adults and that it does NOT automatically mean that there is an infection can help older adults avoid starting courses of antibiotics which may do more harm than good.

Mark Mercure is a Certified Geriatric Pharmacist, practicing at Home Health Care Pharmacy in Brandon. He offers comprehensive medication reviews for older adults to help optimize their medication regimen and achieve positive health outcomes. 

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