Do not use antimicrobials to treat bacteriuria in older adults where specific urinary tract symptoms are not present.
Studies have found that asymptomatic bacteriuria frequently resolves without any treatment. Antimicrobial treatment studies for asymptomatic bacteriuria in older adults demonstrate no benefits and, in fact, often show increased adverse antimicrobial effects.
- Mody L, Juthani-Mehta M. Urinary tract infections in older women: a clinical review. JAMA 2014;311(8):844-54.
- Nicolle LE, Mayhew WJ, Bryan L. Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women. American Journal of Medicine 1987;83(1):27–33.
- Nicolle LE, Bradley S, Colgan R, et al. Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults 2005.
- Zalmanovici Trestioreaunu, Lador A, et al. Antibiotic treatment for asymptomatic bacteriuria. Cochrane Database of Systematic Reviews 2015, Issue 4, Art No CD0009534.
Members of the Australian & New Zealand Society for Geriatric Medicine completed an online survey asking them to choose the 5 most relevant ‘low value’ practices from a list of 11. Respondents were also asked to nominate any additional practices which they regarded as overused, inappropriate or of limited effectiveness in the specialty of geriatric medicine. A total of 196 responses were received.
The list of items were then subject to consideration by the Federal Council. Specifically, members of Federal Council were asked to rate each of these 16 items in terms of their strength in meeting 7 criteria: Is there a reasonable evidence base upon which to drive change? Are older people likely to benefit from work we might do to change practice? Is the problem sizeable? Are there opportunities and a willingness within geriatric medicine to lead practice change? Are there opportunities to collaborate with other organisations with a shared interest in the area? Will this promote a positive profile for ANZSGM? Is this an area of potential conflict with other Societies?
Based on the ratings they assigned to these items the ‘Top 5’ list items were chosen and reformulated as recommendations for clinicians.
- 1 Do not use antipsychotics as the first choice to treat behavioural and psychological symptoms of dementia.
- 2 Do not prescribe benzodiazepines or other sedative-hypnotics to older adults as first choice for insomnia, agitation or delirium.
- 3 Do not use antimicrobials to treat bacteriuria in older adults where specific urinary tract symptoms are not present.
- 4 Do not prescribe medication without conducting a drug regimen review.
- 5 Do not use physical restraints to manage behavioural symptoms of hospitalized older adults with delirium except as a last resort.