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Alternative to antibiotics for managing asymptomatic and non-symptomatic bacteriuria in older persons: a review

02 March 2019
Care of the Older Person
02 March 2019
Volume 24 · Issue 3

Abstract

Recurrent urinary tract infection (UTI) is one of the most common reasons for long-term antibiotic use in frail older people, and these individuals often have non-symptomatic bacteriuria. This article reviews the literature and recommendations for the treatment of UTIs particularly in the older population (>65 years). It considers the question: is there an alternative for antibiotics for asymptomatic and non-symptomatic bacteriuria in older adults? D-mannose powder has been recommended for the treatment of UTIs, as when applied locally, it reduces the adherence of Escherichia coli. In one study, D-mannose was reviewed for the prophylaxis of recurrent UTIs in women, and the findings indicated that it may be useful for UTI prevention instead of prophylactic antibiotics. There is a lack of information about the efficacy of cranberry products combined with D-mannose in this regard, and this is an area for further research.

This article is a review of the literature and recommendations for the treatment of urinary tract infections (UTIs) in the older population (those over 65 years old). The topic discussed is particularly of interest for healthcare professionals working in the community setting, as the cohort of individuals aged over 65 years is known to be prescribed unnecessary antibiotic treatment for asymptomatic bacteriuria (ABU) (NICE, 2018a). Recurrent UTI is also one of the most common reasons for long-term antibiotic use in frail older adults (McClean et al, 2011; 2012; NICE, 2018b). This study asks the question: is there an alternative to antibiotics for ABU and non-symptomatic bacteriuria in older adults? It also explores the recent focus on D-mannose for the prophylaxis and treatment of ABU and recurrent UTIs.

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Asymptomatic and non-symptomatic bacteriuria
Antibiotic prophylaxis
Escherichia coli
Older adults
Recurrent urinary tract infection