Prescribe antibiotics wisely (Clinical points)

Prescribe antibiotics wisely

The overuse and misuse of antibiotics is contributing to the development of antibiotic resistance. 

Adults aged 60 years and older are prescribed antibiotics 1.5 times more than any other age group in Canada. 

Asymptomatic bacteriuria and upper respiratory infections, including sinusitis, are the most likely conditions where antibiotics are prescribed unnecessarily.

• Up to 80% of patients with asymptomatic bacteriuria receive antibiotics. This can lead to adverse events such as C. difficile infections.
• Antibiotics are rarely indicated for upper respiratory illnesses, which are often viral or, if bacterial, are typically self-limited.

KEY CLINICAL POINTS

Asymptomatic bacteriuria:

• The presence of bacteria in the bladder/urine without symptoms pertaining to the urinary tract is referred to as asymptomatic bacteriuria. This represents a colonization state rather than a bacterial infection.
• Pyuria (white blood cells in urine) is very common in asymptomatic bacteriuria and is not an indication for antibiotic therapy.
• Screening urine for bacteriuria or pyuria in an asymptomatic patient or a patient with non-specific symptoms is not recommended.
• Foul smelling, cloudy urine typically indicates dehydration and not a urinary tract infection. These alone are not an indication for sending a urine sample for analysis.
• Non-catheterized patients will typically have specific or localizing symptoms to the urinary tract, such as dysuria, frequency or urgency when a urinary tract infection is present (in older women, acute dysuria is the most discriminating symptom for a urinary tract infection).
• Do not attribute delirium to a urinary tract infection before considering:
  • Dehydration
  • New medication/drug interaction
  • Sleep disturbances
  • Trauma
  • Hypoxia
  • Hypoglycemia
  • Infections other than urinary tract infection