Antibiotic benefits for asymptomatic bacteriuria may not outweigh risks

3 minute read

Elderly patients with asymptomatic bacteriuria appear to suffer more harm than help, according to a major analysis.

The harms of antibiotics may outweigh the benefits in older patients with asymptomatic bacteriuria, new research suggests.  

A recent meta-analysis, published in the British Journal of General Practice, found that the use of antibiotics for the treatment of asymptomatic bacteriuria was associated with an increased risk of adverse effects compared to no treatment.  

“Current evidence suggests no clinical benefit in treating asymptomatic bacteriuria, with no significant differences between antibiotic therapy and no therapy in the development of symptomatic urinary tract infections,” the late Professor Chris Del Mar and colleagues wrote. 

“Although antibiotic therapy was associated with bacteriological cure, it was also associated with significantly more adverse effects,” the evidence-based medicine expert said.   

“The harms and lack of clinical benefit of antibiotic use for older patients in residential aged care facilities may outweigh the benefits.” 

Researchers analysed nine randomised controlled trials of 1400 participants in residential aged care facilities and found that patients on antibiotics had almost six times the rate of adverse effects compared with patients who weren’t given antibiotics.  

The most common side effects were diarrhoea, rash, candidiasis and oral swelling.  

Nevertheless, patients who took antibiotics had almost twice the rate of bacteriological cure compared with people taking a placebo or no therapy. 

They also found a wide range of effectiveness across the studies, which researchers said could be explained by the different types of antibiotic treatment, doses and duration. 

There were several considerations needed when confirming diagnoses in elderly patients, the authors said.  

Members of this population often experienced chronic conditions and/or cognitive impairment, which made recognising and communicating symptoms challenging.  

This could result in the incorrect prescription of medications, including antibiotics, based on poor-quality evidence. 

This is a common problem among residents of aged care facilities, where incidence of infections such as asymptomatic bacteriuria and UTIs is high. The estimated prevalence rate of bacteriuria is 25–50% in females and 15–40% in males.  

The misuse and overuse of antibiotics in residential aged care was a significant issue, contributing to antibiotic resistance, reduced effectiveness and risk of adverse effects.  

Factors including the non-specific nature of symptoms and fear of patient deterioration often led to early initiation of antibiotic therapy as a safety net.  

BJGP 2022, online 1 September 

This article originally ran with the headline ‘Antibiotic benefits for UTIs may not outweigh risks

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