Nursing homes use inappropriate UTI drugs: study

NEW YORK (Reuters Health) - A study at two nursing homes suggests doctors commonly prescribe unnecessary antibiotics to elderly people with suspected urinary tract infections (UTIs).

Two out of every five residents with urinary problems got inappropriate drugs, researchers found, which in turn increased their chance of getting a bacterial infection.

"We tend to over-utilize antibiotics, many times if family or the nursing home requests them," said Dr. David Dosa of Brown University in Providence, Rhode Island, who worked on the study.

Doctors are only supposed to treat a UTI with antibiotics if the patient meets certain criteria. Dosa said overuse can lead to drug-resistant bacteria and so increase the risk of hard-to-treat infections.

Over six months, one out of seven people that received UTI antibiotics in the nursing homes came down with Clostridium difficile, a bacterium in the digestive tract that can cause diarrhea, cramps and sometimes life-threatening inflammation of the colon.

"Patients and relatives should allow doctors to make educated decisions based on existing guidelines," rather than asking for antibiotics as soon as patients get an infection, Dosa said.

The researchers looked at 172 cases of suspected UTIs at two Rhode Island nursing homes. Of those, 26 met the criteria for antibiotic treatment. On the other hand, 70 people who didn't qualify for treatment got the drugs.

Dosa, whose findings appear in the Archives of Internal Medicine, said fear of undertreating might lead some doctors to prescribe antibiotics too loosely.

"We're creating a massive problem that's going to make life incredibly difficult in the future, in terms of drug resistance," Dosa told Reuters Health.

UTIs occur when bacteria enters the urethra, then the bladder. Untreated, they can cause kidney damage or infection, or in rare cases life-threatening blood infections.

According to the researchers, the disease is especially common in nursing homes, affecting nearly half the residents at some point during their stay.

To be treated with antibiotics, patients should have three out of five symptoms described in current UTI guidelines, such as a fever or a burning sensation while urinating.

But physicians may differ on when it's appropriate to use antibiotics, said Dr. Thomas Hooton, an expert in infectious diseases at the University of Miami Miller School of Medicine.

"There's no law that says the guideline is perfect for each individual patient," Hooton, who was not involved in the study, told Reuters Health.

The guidelines are based on younger, healthy people, he added, and may not be ideal for nursing home residents, who tend to have different types of UTIs.

Still, Hooton said eliminating inappropriate antibiotic use is an important goal, and the new study should make us rethink how we use the drugs.

SOURCE: bit.ly/f1C1F9 Archives of Internal Medicine, online March 14, 2011.