Choosing Wisely: Antibiotics for urinary tract infections

Antibiotics usually don't help when there are no UTI symptoms

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 in older people.

People without symptoms should not be tested or treated for a UTI unless they are pregnant or about to have some types of surgery – for example, prostate surgery and some procedures to remove kidney stones or bladder tumors.

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, diarrhoea, nausea, vomiting, headache, tendon ruptures, and nerve damage.

Antibiotics can cause future problems

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

Also, antibiotics 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.

When should you 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.

More information

Steps to prevent UTIs

Drink water. Most healthy people should drink 6 to 8 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.

It’s OK to ask questions

If you have questions about your symptoms or the medicines managing your symptoms, speak with your health professional.

Supporting evidence

• Best Practice Advocacy Centre New Zealand (bpac^nz). A pragmatic guide to asymptomatic bacteriuria and testing for urinary tract infections (UTIs) in people aged over 65 years. Best Tests, 27 July 2015 https://bpac.org.nz/BT/2015/July/guide.aspx
• Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A , Hooton TM. Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults. Clinical Infectious Diseases 2005;40:643-54.
• Ariathianto Y. Asymptomatic bacteriuria: Prevalence in the elderly population. Australian Family Physician. 2011:40(10):805-9.
• Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2014.
• Jarvis TR, Chan L, Gottlieb T. Assessment and management of lower urinary tract infection in adults. Australian Prescriber 2014;37:7-9.

Developed by Choosing Wisely New Zealand, 2018. Adapted from Choosing Wisely Canada (2013), “Antibiotics for Urinary Tract Infections in Older People”. Choosing Wisely does not assume any responsibility or liability arising from any error or omission or from the use of any information in these resources.