UTI + functional decline
Frailty syndromes are common presentations to hospital and may involve falls, immobility, delirium and incontinence. The causes of functional decline in patients with frailty are numerous and can include drug adverse effects, metabolic or organ dysfunction, cerebral vascular events and infection.
Many patients with frailty presenting to the hospital are not suffering from an infection and can safely be observed after performing a septic screen without commencing antibiotics. Patients with clear evidence of sepsis should have prompt commencement of antibiotics Sepsis Identification and Management
Dipsticks become unreliable in older age. Upto half of older adults will have bacteria in the urine without an infection (Asymptomatic bacteruria). See also Use of dipsticks when diagnosing UTI
Treat according to culture and sensitivity test results.
Treat for 3 days
Preferred
nitrofurantoin 50mg po qds (caution: do not use if eGFR is under 45 ml/min/1.73m2)
Adverse effects have been reported with nitrofurantoin see Nitrofurantoin MHRA drug safety updates
Alternative
For renal impairment (eGFR less than 45mL/min/1.73m2):
trimethoprim 200mg po bd
Frailty syndromes
- Clinical Frailty Scale see HERE
- See British Geriatric Society Frailty: what's it all about?
- See NHS Rightcare: Frailty Toolkit