What are the appropriate discharge instructions for an elderly patient with a urinary tract infection (UTI)?

UTI Discharge Instructions for Elderly Patients

Complete your full antibiotic course even if symptoms improve, and return immediately if you develop fever, confusion, inability to urinate, or worsening symptoms within 48-72 hours. 1, 2

Medication Instructions

Taking Your Antibiotics

• Take your prescribed antibiotic exactly as directed - the most commonly prescribed options include fosfomycin (single 3g dose), nitrofurantoin (if kidney function is adequate), or trimethoprim-sulfamethoxazole (if local resistance is low). 1, 2
• Do not stop taking antibiotics early even if you feel better - incomplete treatment can lead to recurrent infection and antibiotic resistance. 1
• If you were prescribed fosfomycin, you only need to take one dose mixed with water, which works regardless of kidney function. 2
• If you were prescribed nitrofurantoin, take it with food to reduce stomach upset, but this medication should not be used if you have significantly reduced kidney function (creatinine clearance <30 mL/min). 1, 2

Important Medication Warnings

• Avoid fluoroquinolones (ciprofloxacin, levofloxacin) unless specifically prescribed, as these carry increased risks of tendon rupture, confusion, and other serious side effects in elderly patients. 1, 2
• Report any new confusion, dizziness, falls, or unusual weakness immediately, as these may indicate medication side effects or worsening infection. 1
• If taking trimethoprim-sulfamethoxazole, watch for signs of low blood sugar, unusual bruising, or high potassium levels (muscle weakness, irregular heartbeat). 2

Hydration and Self-Care

Fluid Intake

• Drink 6-8 glasses of water daily unless your doctor has restricted your fluid intake for heart or kidney problems. 2
• Adequate hydration helps flush bacteria from your urinary system and prevents kidney damage. 2

Symptom Management

• Dysuria (burning with urination) should improve within 48-72 hours of starting antibiotics - if it doesn't, contact your healthcare provider. 1, 2
• Urinary frequency and urgency typically improve within 2-3 days of treatment. 2
• Do not use over-the-counter urinary pain relievers (phenazopyridine) for more than 2 days, and only if prescribed by your doctor. 2

When to Seek Immediate Medical Attention

Red Flag Symptoms

• Fever above 100°F (37.8°C), shaking chills, or rigors - these indicate possible bloodstream infection requiring urgent evaluation. 2
• New or worsening confusion, delirium, or altered mental status - common signs of serious infection in elderly patients. 1, 2
• Inability to urinate, severe back/flank pain, or blood in urine - may indicate kidney involvement or obstruction. 1, 2
• No improvement in symptoms after 48-72 hours of antibiotic treatment - your antibiotic may need to be changed based on culture results. 1

Other Concerning Signs

• Severe nausea, vomiting, or inability to take medications - you may need intravenous antibiotics. 1
• New falls, severe weakness, or functional decline - atypical presentations of worsening infection in elderly patients. 1
• Signs of allergic reaction including rash, difficulty breathing, or swelling of face/lips/tongue. 1

Follow-Up Care

Scheduled Appointments

• Attend your follow-up appointment even if you feel better - your doctor needs to confirm the infection has cleared. 1
• Bring a list of all medications you're taking to discuss potential interactions. 2
• Your urine culture results will guide whether your antibiotic needs to be changed or continued. 1, 2

Monitoring at Home

• Keep track of your symptoms - note if dysuria, frequency, or urgency persist beyond 3 days. 2
• Monitor your temperature daily for the first 3 days of treatment. 2
• Watch for medication side effects including diarrhea, nausea, rash, or dizziness. 1, 2

Prevention of Future UTIs

Lifestyle Modifications

• Maintain adequate daily fluid intake to help prevent recurrent infections. 3
• Practice good perineal hygiene - wipe front to back after bowel movements. 3
• Empty your bladder completely when urinating and don't delay urination when you feel the urge. 3
• Manage underlying conditions such as diabetes, as poor blood sugar control increases UTI risk. 3

Catheter Care (If Applicable)

• If you have a urinary catheter, it should only remain in place if absolutely necessary for urinary retention, obstruction, or specific medical conditions. 4
• Discuss catheter removal with your doctor as soon as medically appropriate, since catheter-associated complications increase with each day of use. 4
• Keep the catheter insertion site clean and dry with frequent perineal care. 4

Critical Information About Asymptomatic Bacteriuria

What NOT to Treat

• If you have bacteria in your urine but NO symptoms (no dysuria, frequency, urgency, fever, or confusion), this is called asymptomatic bacteriuria and should NOT be treated with antibiotics. 1, 2
• Asymptomatic bacteriuria occurs in 40% of institutionalized elderly patients and causes no harm - treating it only promotes antibiotic resistance. 2, 5
• Positive urine tests alone (cloudy urine, positive dipstick) without symptoms do NOT require antibiotics. 1, 2

Medication-Specific Renal Adjustments

If You Have Kidney Disease

• Your antibiotic dose may need adjustment based on your kidney function - never adjust doses yourself. 1, 2
• Fosfomycin is the safest option for patients with reduced kidney function as it doesn't require dose adjustment. 1, 2
• Avoid nitrofurantoin if your creatinine clearance is below 30 mL/min due to inadequate urinary concentrations and increased toxicity risk. 2
• Stay well-hydrated to protect your kidneys, but follow any fluid restrictions your doctor has prescribed. 2

Drug Interactions and Polypharmacy

Important Considerations

• Review all your medications with your pharmacist to check for interactions with your UTI antibiotic. 2
• Trimethoprim-sulfamethoxazole can interact with blood thinners, diabetes medications, and blood pressure pills - monitor closely for side effects. 2
• Report all supplements and over-the-counter medications you're taking, as these can interact with antibiotics. 2