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Antimicrobials
Change the catheter if present >2wks, and remove if not indicated
There is a high prevalence of asymptomatic bacteriuria and pyuria in nursing home patients, which does NOT require treatment (leads to resistance).
UTI should only be diagnosed and treated in patients with genitourinary symptoms.
For patients with nonspecific symptoms (falls, change in mental status) without signs of sepsis, improving hydration often resolves symptoms - suggest withholding ABx 24hrs and reassess
Contributing factors to UTI should be assessed and managed where possible: i.e. cystocele, incomplete bladder emptying, vaginal atrophy
Review previous urine culture data if recurrent UTI
Nitrofurantoin (if GFR>30) 100 mg PO BID
OR
Fosfomycin 3g PO once for women
Amoxicillin-Clavulanate 500 mg PO TID