From the Research
For an 85-year-old female with hematuria and positive leukocytes, I recommend prompt evaluation for a urinary tract infection (UTI) and starting empiric antibiotic therapy with nitrofurantoin (Macrobid) 100mg twice daily for 7 days, as it is still effective against most uropathogens, according to the most recent evidence 1. The patient's symptoms, including hematuria and positive leukocytes, suggest a UTI, which is a common condition in elderly women due to shortened urethras, decreased estrogen, and changes in vaginal flora 1.
- Key considerations in the treatment of UTIs in elderly women include:
- Ensuring adequate hydration with 1.5-2 liters of fluid daily
- Collecting a clean-catch midstream urine sample for culture before starting antibiotics to confirm the infection and guide therapy
- Monitoring for improvement within 48-72 hours, with persistent symptoms warranting reassessment
- Assessing for complicating factors like incomplete bladder emptying, anatomical abnormalities, or kidney stones
- The combination of hematuria and leukocytes strongly suggests infection, but other diagnoses, including bladder cancer, especially with gross hematuria, should also be considered 2.
- UTIs in elderly women can lead to complications like pyelonephritis or sepsis if not properly diagnosed and treated, making prompt evaluation and treatment essential 1.
- The choice of antibiotic should be guided by local resistance patterns and the patient's renal function, with nitrofurantoin being a suitable option for many patients 1.