Harmless bugs in urine don t merit antibiotics

Urinary tract infections (UTI) are common enough, but a study just published in the Archives of Internal Medicine found that doctors too often prescribe antibiotics for bacteria in the urine when a patient s condition does not actually warrant it. The downsides of such needless treatment are potentially serious: It exposes patients to unnecessary risks of drug reaction and increases the possibility of inducing the development of drug-resistant bacteria.

For the study, researchers from the Veterans Affairs Medical Center and the MD Anderson Cancer Center in Houston analyzed the medical records of 339 patients, most of whom who were older males and whose urine had tested positive for a specific type of bacterium. Based on patients lab tests and symptoms, the researchers determined that 156 of these patients had an actual infection, while 183 had what is called a bacterial colonization with no sign of infection. However, 60 of the latter group had been treated with antibiotics anyway a practice that is against the guidelines of the Infectious Diseases Society of America.

In their paper, the researchers reiterate that antibiotics are necessary only when bacteria in the urine is accompanied by symptoms of UTI namely, pain on urination, increased urgency or frequency of urination, blood in the urine, cloudy urine, pain near the bladder, and fever. Otherwise, bacteria in the urine will most likely disappear on its own without causing any problems. To prescribe a broad-spectrum (often, a quinolone-type) antibiotic for such instances of colonization increases the chances of resistance, given that these drugs target a wide range of bacteria.

ACSH's Dr. Gilbert Ross agrees that a healthcare provider should find evidence of an actual infection first before prescribing antibiotics for the mere presence of bacteria in the urine. However, he notes that there are some important exceptions to this rule cases where an early prescription is warranted: Pregnant women, patients with recurring UTIs, and those who are immunocompromised should be treated as soon as bacteria are found in their urine.