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Urinary tract infection (UTI) is the most widespread problem, especially among women. It is observed the second most common incidence in primary and secondary care that requires antibiotic treatment (Shah & Goundrey-Smith, 2013). The UTI incidences are high among women and around 50% women face it once in their lifetime. The statistics suggest that women are more prone to UTIs in comparison to men and data shows that 7-8% women between the age of 60-80 and around 20% women above the age of 80 years are more susceptible (Naish & Hallm, 2007). The etiological factors for UTI among women are increasing age, active sexual life, institutionalization, co-morbidities such as diabetes and catheter-use (Naish & Hallm, 2007).
This research targets to discover that how antibiotics can be used as a preventive measure against UTI among elderly, specifically women. This paper proposes a conceptual framework (See figure 1) that portrays the approach of using antibiotic for treating UTI in elderly patients.
Figure 1: Conceptual framework showing Antibiotic use in UTI
Based on a literature review of previously conducted studies the management of UTI among elderly patients requires more attention in comparison to younger groups. Often UTI remains asymptomatic, but an older infection can develop certain severe risks of renal failures and other co-morbidities. The recommended management plans of UTI emphasize first to focus the medical history, age, etiology, risk factors and types of infections (Nazarko, 2014).
The symptoms of UTI in elderly are fever, frequency and dysuria while several atypical symptoms include altered mental state, nausea and vomiting and urinary retention. Choosing an appropriate antibiotic for an elderly patient is the first essential step which is a complex task because, at this age both, the range and extent of the pathogen are high that lead to the risk of greater resistance especially to the patients who are institutionalized and had recurrent antibiotics courses. Other present risks are linked to co-morbidity such as renal insufficiency and the associated medication (Nazarko, 2014; Cove‐Smith & Almond, 2007).
It is observed that the resistance of E. coli isolates is high against amoxicillin (48.7%) thus it is recommended as first-line therapy. For such purpose, Co-amoxiclav has shown prominent efficacy with 78.8% while 95% E. coli isolates demonstrated high sensitive against cefuroxime and nitrofurantoin (Cove‐Smith & Almond, 2007).
Previous studies advice not to prescribe antibiotics until the urine test results are clear or patient is showing any severe symptom. Choosing a suitable antibiotic on the basis of the result protects from the unnecessary use of antibiotics. The best practice is to assess the antibiotic choice for 48 to 72-hour duration in the consideration of the urine culture results. For lower UTIs trimethoprim is a rational choice, but against gram negative microbes’ aminoglycosides is a suitable agent. In the case of acute pyelonephritis, the second- or third-generation cephalosporins are advised as first-line empirical therapy (Cove‐Smith & Almond, 2007).
In elderly UTI cases the more importance is given to the drug monitoring and in the case of any reaction associated with the antibiotic administration, the antibiotic regimen should be changed instantly. The duration of the antibiotic course is contradictory in various researches. Experts believe that a short treatment of seven-days is the most suitable and effective approach to treat UTIs in elderly. The overtreatment is prohibited, and if the condition could not be cured within these days, it indicates any other underlying cause such as structural renal tract abnormality, diabetes mellitus, and antibiotic resistance. In such cases, other measures are taken that include dose adjustment, antibiotic replacement and in the case of catheterized patient, catheter is immediately removed.
On the basis of evidence-based practices, it is concluded that antibiotics are the best approach to treat UTIs in elderly, but the excessive administration should be avoided.
References
Nazarko, L. (2014). Recurrent urinary tract infection in older women. Nurse Prescribing,
12(12).Nurse Prescribing.
Cove‐Smith, Andrea, & Almond, M. K. (2007). Management of urinary tract infections
in the elderly. Trends in Urology, Gynaecology & Sexual Health, 12(4), 31-34.
Shah, C., & Goundrey-Smith, S. (2013). Managing the symptoms of urinary tract infection in
women. Journal of community nurse, 88-92.
