I guess doctors don't know what they are doing. A new study claims that physicians are overprescribing antibiotics for urinary tract infections for elderly patients in the nursing home. My gut feeling is that these results may be flawed. In the Archives of Internal Medicine,
the researchers looked at 172 cases of suspected UTIs at two Rhode Island nursing homes. Of those, 26 met the criteria for antibiotic treatment and 70 people who didn't qualify for treatment still got the drugs. The criteria were the three of the following:
1) a temperature of 38°C or higher; (2) new or increased burning sensation on urination, increased frequency of urination, or urgency of urination; (3) new flank or suprapubic pain or tenderness; (4) change in character of urine; and (5) worsening of mental or functional status
Here are the problems that I see with these criteria. Getting a high temp on an elderly patient is rare. They also rarely feel burning with urination. Many are incontinent of urine, anyway. A lot of elderly have back pain ALL the time. The character of urine is a bogus sign for all ages. The last issue, worsening of mental or functional status is probably the most important symptom. Of the five, you had to have three to meet the criteria for appropriately treating UTIs. Trust me, this is not going to happen in nursing home patients.
Once again the media went overboard in slamming doctors by hyping this study. The study is cited all over the place in papers and on the internet. With that comes accusations that doctors are just doing bad work. Not true. In fact, the actual study was called "Potentially Inappropriate Treatment of Urinary Tract Infections in Two Rhode Island Nursing Homes". The key word is "potentially". Let's not make mountains out of mole hills here.
the researchers looked at 172 cases of suspected UTIs at two Rhode Island nursing homes. Of those, 26 met the criteria for antibiotic treatment and 70 people who didn't qualify for treatment still got the drugs. The criteria were the three of the following:
1) a temperature of 38°C or higher; (2) new or increased burning sensation on urination, increased frequency of urination, or urgency of urination; (3) new flank or suprapubic pain or tenderness; (4) change in character of urine; and (5) worsening of mental or functional status
Here are the problems that I see with these criteria. Getting a high temp on an elderly patient is rare. They also rarely feel burning with urination. Many are incontinent of urine, anyway. A lot of elderly have back pain ALL the time. The character of urine is a bogus sign for all ages. The last issue, worsening of mental or functional status is probably the most important symptom. Of the five, you had to have three to meet the criteria for appropriately treating UTIs. Trust me, this is not going to happen in nursing home patients.
Once again the media went overboard in slamming doctors by hyping this study. The study is cited all over the place in papers and on the internet. With that comes accusations that doctors are just doing bad work. Not true. In fact, the actual study was called "Potentially Inappropriate Treatment of Urinary Tract Infections in Two Rhode Island Nursing Homes". The key word is "potentially". Let's not make mountains out of mole hills here.
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