From the Guidelines
Women over 90 with urinary tract infection (UTI) symptoms should be treated with antibiotics such as nitrofurantoin (Macrobid) 100mg twice daily for 5 days, trimethoprim-sulfamethoxazole (Bactrim) DS twice daily for 3 days, or fosfomycin (Monurol) as a single 3-gram dose, taking into account their comorbidities, polypharmacy, and potential adverse events 1.
Key Considerations
- UTIs in elderly women often present with atypical symptoms, including confusion, agitation, lethargy, decreased appetite, or worsening incontinence, rather than the classic burning sensation during urination 1.
- Diagnosis is complicated by the high prevalence of asymptomatic bacteriuria, which does not require treatment, and the low specificity of urine dipstick tests in this population 1.
- Treatment strategies generally align with those for younger people, but it is crucial to consider comorbidities, polypharmacy, and potential adverse events 1.
Management
- Increased fluid intake, especially water, can help flush bacteria from the urinary system.
- Cranberry products may provide some preventive benefit.
- Prompt treatment is essential to prevent serious complications, including kidney infection or sepsis.
Patient Population
- Frail patients are characterized by specific vulnerabilities and health risks due to diminished physiological functions.
- Geriatric patients, usually aged >70 years, exhibit multimorbidity involving two or more systemic diseases that have resulted in significant damage to body functions and structures 1.
From the Research
UTI Symptoms in Females
- Urinary tract infections (UTIs) are common bacterial infections, particularly in women 2
- The female to male ratio of UTIs decreases with increasing age, but UTIs are still more frequent in women than men 3
Common Uropathogens
- Escherichia coli is the most common cause of symptomatic UTIs in women without complicating factors 3, 2
- Other common uropathogens include Gram-negative bacteria, such as Klebsiella pneumoniae and Pseudomonas spp. 4
Treatment Options
- First-line treatment for acute uncomplicated UTIs in women includes nitrofurantoin, fosfomycin, and pivmecillinam 4, 2
- Alternative treatment options include fluoroquinolones, such as ciprofloxacin and levofloxacin, and oral cephalosporins, such as cephalexin and cefixime 4, 5
- For UTIs caused by extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales, treatment options include nitrofurantoin, fosfomycin, and carbapenems 4
Special Considerations
- Asymptomatic bacteriuria should not be treated, as it is not associated with morbidity or mortality 3
- UTIs in postmenopausal women and pregnant women require special consideration, as they may have different treatment options and risks 2
- Recurrent UTIs in women may require longer treatment courses or alternative treatment options 2