Does treatment of asymptomatic bacteriuria in older ambulatory women reduce subsequent symptoms of urinary tract infection?
OBJECTIVE
To determine whether treatment of symptomatic bacteriuria in older ambulatory women affects the subsequent development of symptoms of urinary tract infection.


METHODS
A controlled clinical trial.


METHODS
Older women not having urinary catheters.


METHODS
Urine cultures every 6 months (the same organism at 10(5) colony-forming units or more per mL on two midstream urine specimens defined asymptomatic bacteriuria) and questionnaire surveys for the new development of symptoms of urinary tract infection (dysuria, frequency, urgency, low back pain with fever) 1, 3, and 6 months after the initial survey.


RESULTS
Of the 23 initially culture-positive participants receiving antibiotic treatment for symptomatic bacteriuria, nine were culture positive at 6 months, which contrasts with 18 of 27 who received no treatment or placebo, P = .05. However, symptoms of urinary tract infection were more common in the antibiotic-treated group.


CONCLUSIONS
Antibiotic therapy effectively reduced the subsequent occurrence of positive urine cultures, but symptoms were not reduced. Based on this study of morbidity, previous studies failing to show any relation to mortality, and the cost and complications of antibiotic therapy in the older population, treatment of asymptomatic bacteriuria in older women is contraindicated.
Abrutyn
E
E
Medical College of Pennsylvania, Philadelphia, USA.
Berlin
J
J
Mossey
J
J
Pitsakis
P
P
Levison
M
M
Kaye
D
D
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D001437:Bacteriuria / Q000150:complications* / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control*
D000892:Anti-Infective Agents, Urinary