Core Concepts
Accurately diagnosing and treating recurrent urinary tract infections (rUTIs) in older women is complex due to age-related conditions, requiring careful consideration of risks and benefits of various treatment options.
Abstract
The content highlights the challenges in accurately diagnosing recurrent urinary tract infections (rUTIs) in older women aged 65 and above. Key points:
- Older women have double the rUTI rates compared to younger women, but detection is more complicated due to age-related conditions like overactive bladder related to menopause.
- Overuse of antibiotics can increase the risk of antibiotic-resistant organisms and lead to toxic effects in women with reduced kidney function. Up to 20% of older women have bacteria in their urine, which may or may not reflect a rUTI.
- Diagnosing rUTIs is further complicated if women have dementia or cognitive decline, which can hinder recollection of symptoms.
- Clinicians should only test for rUTIs when symptoms are present and consider all possibilities before making a diagnosis.
- Vaginal estrogen may be an effective treatment, but there is a lack of uniform formulation to recommend. Oral estrogen use is not supported by evidence.
- The drug methenamine may be as effective as antibiotics but may not be safe for women with comorbidities. Daily use at 1 g is supported by evidence.
- Cranberry supplements and behavioral changes may be helpful, but evidence is limited, including among women in long-term care facilities.
- Shared decision-making is crucial when the diagnosis of an rUTI episode is unclear, as clinicians should acknowledge the limitations in the evidence and discuss preferences with patients or their caregivers.
Stats
Older women have double the rUTI rates compared with younger women.
Up to 20% of older women have bacteria in their urine, which may or may not reflect a rUTI.
Evidence supports daily use of methenamine at 1 g.
Quotes
"Shared decision-making is especially important when diagnosis of an rUTI episode in older women is unclear…in these cases, clinicians should acknowledge limitations in the evidence and invite patients or their caregivers to discuss preferences about presumptive treatment, weighing the possibility of earlier symptom relief or decreased UTI complications against the risk of adverse drug effects or multidrug resistance."