Advertisement

Asymptomatic Bacteriuria in Freely Voiding Elderly Subjects

Long-Term Continuous vs Pulse Treatment with Ofloxacin

Summary

The aim of this open, randomised study was the comparison of 3-month continuous (group A, n = 34) vs pulse oral ofloxacin therapy (group B, n = 33) in eliminating asymptomatic bacteriuria over 3 further months in 64 freely voiding, ambulant, very old subjects (mean age 83 years). A positive (group C, n = 29) and a negative control (group D, n = 40) were run simultaneously; two subjects in group A were withdrawn because of adverse effects. During therapy 86.7% of 30 cultures, 84.4% of 32 cultures and 24.1 % of 29 cultures in groups A, B and C, respectively, had sterile urine (A + B vs C: p < 0.001), whereas 12.8% of 39 cultures (group D) developed positive urine. At 3 months post-therapy 57.2%, 53.1%, 25.9% and 84.2% of 28, 32, 27 and 38 cultures, respectively, of the above groups remained free of infection (A + B vs C: p < 0.012); >50% of positive cultures in groups A+ B were due to new microorganisms, resistant to ofloxacin. Mild decreases in serum creatinine occurred in the treated subjects; haematocrit, serum bilirubin, blood urea, and SGPT were not affected. No deterioration in mobility occurred in any group, and the overall mortality (5 deaths) not connected with underlying urinary tract infection was low. It was concluded that: (a) ofloxacin pulse therapy was about equal to a continuous regimen in eliminating bacteriuria (>80% sterile urine) for 3 months, with negative cultures at a 3-month follow-up in ≥50%; (b) recurrences were caused chiefly by ofloxacin-resistant organisms; (c) serum creatinine indicated a trend towards lower values in the treated groups; (d) compliance was better and costs were much less in the pulse therapy group. Thus, if required, 3-month pulse therapy can be safely used to keep the urinary tract free of infecting microorganisms.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 49.95

Price includes VAT for USA

References

  1. 1.

    Baldassarre J, Kaye D. Special problems of urinary tract infection in the elderly. Med Clin North Am 1991; 5(2): 375–90

  2. 2.

    Lye M. Defining and treating urinary infections. Geriatrics 1978; 33: 71–7

  3. 3.

    Akhtar AJ, Andrews GR, Caird Fallow RJ. UTI in the elderly. A population study. Age Ageing 1972; 1: 48–54

  4. 4.

    Boscia JA, Kobasa WD, Knight RA. Epidemiology of bacteriuria in an elderly ambulatory population. Am J Med 1986; 80: 208–14

  5. 5.

    Eberle CM, Winsemius D, Garibaldi LA. Risk factors and consequences of bacteriuria in non-catheterized nursing home residents. J Gerontol 1993; 48: M266–71

  6. 6.

    Brocklehurst JC, Dillane JB, Griffiths L, et al. The prevalence and symptomatology of urinary infection in an aged population. Gerontol Clin 1968; 10: 242–53

  7. 7.

    Dontas AS. Urinary tract infections and their implications. In: Brocklehurst JC, editor. Urology in the elderly. Edinburg: Churchill Livingstone, 1984; 162–92

  8. 8.

    Ouslander JG, Schapira M, Schnelle JF, et al. Does eradicating bacteriuria affect the severity of chronic urinary incontinence in nursing home residents? Ann Intern Med 1995; 122: 749–54

  9. 9.

    Kasviki-Charvati P, Drolette-Kefakis B, Papanayiotou PC, et al. Turnover of bacteriuria in old age. Age Ageing 1982; 11: 169–74

  10. 10.

    Sourander LB. Urinary tract infection in the elderly. An epidemiological study. Ann Med Intern Fenn 1966; 45: S1–S55

  11. 11.

    Wolfson SA, Kalmanson GM, Rubini ME. Epidemiology of bacteriuria in a predominantly geriatric male population. Am J Med 1965; 250: 168–73

  12. 12.

    Dontas AS, Papanayiotou P, Marketos S. Bacteriuria in old age. Lancet 1966; II: 305–6

  13. 13.

    Dontas AS, Kasviki-Charvati P, Papanayiotou P, et al. Bacteriuria and survival in old age. N Engl J Med 1981; 304: 939–43

  14. 14.

    Boscia JA, Kobasa WD, Abrutyn E, et al. Lack of association between bacteriuria and symptoms in the elderly. Am J Med 1986; 81: 979–82

  15. 15.

    Kunin CM. Does kidney infection cause renal failure? Ann Rev Med 1985; 36: 165–76

  16. 16.

    Asscher AW. Urinary tract infection. Lancet 1974; 2: 1365–7

  17. 17.

    Cattell WR. The management of UTI. Practitioner 1974; 212: 27–36

  18. 18.

    Carty M, Brocklehurst JC, Carty J. Bacteriuria and its correlates in old age. Gerontology 1981; 27: 72–5

  19. 19.

    Sourander LB, Kasanen A. A five-year follow-up of bacteriuria in the aged. Gerontol Clin 1972; 14: 274–81

  20. 20.

    Heinamaki P, Haavisto M, Hakulinen T, et al. Mortality in relation to urinary characteristics in the very aged. Gerontology 1986; 32: 167–71

  21. 21.

    Nicolle LE, Bjornson J, Harding GKM, et al. Bacteriuria in elderly institutionalized men. N Engl J Med 1983; 309: 1420–5

  22. 22.

    Nordenstam GR, Brandberg A, Oden AS, et al. Bacteriuria and mortality in an elderly population. N Engl J Med 1986; 314: 1152–6

  23. 23.

    Boscia JA, Kobasa WD, Knight RA, et al. Therapy vs no therapy for bacteriuria in elderly ambulatory nonhospitalized women. JAMA 1987; 257: 1067–71

  24. 24.

    Nicolle LE, Mayhew WJ, Bryan L. Prospective, randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women. Am J Med 1987; 83: 27–33

  25. 25.

    Dontas AS, Toupadaki N, Tzonou A, et al. Survival in the oldest old. Death risk factors in old and very old subjects. J Aging Health 1996; 8: 220–37

  26. 26.

    Abrutyn E, Mossey J, Berlin JA, et al. Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women? Ann Intern Med 1994; 120: 827–33

  27. 27.

    Staszewska-Pistoni M, Dontas AS, Giamarellou H, et al. Controlled ten-day antimicrobial therapy in asymptomatic bacteriuria of old age; relations with localization, mobility and mortality. Geriatric Nephrol Urol 1995; 4: 137–43

  28. 28.

    Tzias V, Dontas AS, Petrikkos G, et al. Three-day antibiotic therapy in bacteriuria of old age. J Antimicrob Chemother 1990; 26: 705–11

  29. 29.

    Brumfitt W. Urine cell counts and their value. J Clin Pathol 1965; 18: 550–5

  30. 30.

    Performance standard for antimicrobial disk susceptibility tests approved standard ASM-2. 2nd ed. Villanova: National Committee for Clinical Laboratory Standards, 1979

  31. 31.

    Castleden CM, Duffin HM, Assher MJ. Clinical and urodynamic studies in 100 elderly incontinent patients. BMJ 1981; 282: 1103–5

  32. 32.

    Williams ME, Pannill FC. Urinary incontinence in the elderly: physiology, pathophysiology, diagnosis and treatment. Ann Intern Med 1982; 97: 895–907

  33. 33.

    Raz R, Stamm WE. A controlled trial of intravaginal estriol in the post menopausal women with recurrent urinary tract infections. N Engl J Med 1993; 329: 753–6

  34. 34.

    Svanborg C. Resistance to urinary tract infection. N Engl J Med 1993; 329: 802–3

  35. 35.

    Ouslander JG, Schnelle JE Incontinence in the nursing home. Ann Intern Med 1995; 122: 438–49

  36. 36.

    Giamarellou H, Iakovou M, Pistoni M, et al. Kinetics and comparative efficacy of ofloxacin vs cotrimoxazole in the asymptomatic bacteriuria of elderly subjects. Chemotherapy 1991; 37(SI): 19–24

  37. 37.

    Hooper D, Wolfson J. Fluoroquinolone antimicrobial agents. N Engl J Med 1991; 324: 384–94

  38. 38.

    Tolkoff-Rubin NE, Rubin RH. New approaches to the treatment of UTI. Am J Med 1987; 82(4A): 270–7

Download references

Author information

Correspondence to Prof. Helen Giamarellou.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Giamarellou, H., Dontas, A.S., Zorbas, P. et al. Asymptomatic Bacteriuria in Freely Voiding Elderly Subjects. Clin. Drug Investig. 15, 187–195 (1998). https://doi.org/10.2165/00044011-199815030-00003

Download citation

Keywords

  • Adis International Limited
  • Ofloxacin
  • Nursing Home Resident
  • Drug Invest
  • Bacteriuria