Urinary tract infection in the elderly. How to treat and when?

The prevalence of urinary infection increases with increasing age for both men and women, reaching over 50% for both sexes amongst institutionalized patients. Bacteriuria is, generally, asymptomatic, and asymptomatic bacteriuria is not an indication for therapy, except prior to invasive genitourinary procedures. Treatment has not been shown to prevent subsequent symptomatic episodes, is associated with antimicrobial adverse effects, and promotes the emergence of resistant organisms. In addition, early recurrence is the rule following therapy in the institutionalized elderly and prolonged periods free of bacteriuria are seldom achieved. Symptomatic infection may manifest as invasive infection or irritative symptoms. Antimicrobial therapy is selected on the basis of organism susceptibility and patient tolerance. Therapy of 7-14 days is suggested, as short course therapy is not as effective in older women. For men, initial courses of therapy of 7-14 days are likely to be appropriate. As prostatic localization is frequent, recurrent symptomatic infection may require more prolonged therapy of six or 12 weeks. Bacteriuria in the elderly is a large and complex problem. Overuse of antimicrobials should be avoided, but further investigations to characterize the optimal use of antimicrobials are still required.