Less is More When Getting Rid of Bacteria

Antibiotic treatment is not necessary for everyone with urinary bacteria

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) People with bacteria in their urine may go on to develop an infection that needs drug treatment. Other people with the same bacteria will never become infected. Yet some doctors still treat these patients as if they were sick.

Some doctors are over-treating people with bacteria in their urine but with no signs of urinary tract infection. These doctors are prescribing antibiotics to patients whose bodies are likely to get rid of the bacteria on their own.

"Make sure your prescription is needed to treat your condition."

In some cases, a type of bacteria in the urine (called enterococcal bacteriuria) can cause urinary tract infections - infections that begin in the kidneys, ureters, bladder, or urethra. If left untreated, urinary tract infections can lead to kidney infections and permanent kidney damage. However, the presence of this bacteria does not necessarily mean that a person will develop an infection.

For a recent study, Barbara W. Trautner, M.D., Ph.D., of the Baylor College of Medicine, and colleagues wanted to see if doctors were following the current guidelines for treating this urinary bacteria.

Antibiotics are generally reserved for people with infections. The researchers found that some doctors were prescribing antibiotics to people who did not need the drugs, especially to those with pyuria - or the presence of pus in the urine.

While these people had bacteria in their urine, they did not have urinary tract infections. Even some patients with pyuria - which is often a sign of urinary tract infection - were not infected. Still, many uninfected patients were treated with antibiotics.

"I think doctors may jump the gun with antibiotics in symptomatic patients for fear that the patient's symptoms may become worse and/or the patient will develop pyelonephritis if appropriate treatment is not started early," says Pamela Ellsworth, M.D., a urologist and co-author of the book Questions and Answers About Overactive Bladder.

"The concept of bacteriuria - i.e. bacteria in the urine - without a [urinary tract infection] is not well understood by many physicians, and there is a tendency to treat all positive cultures regardless of whether or not the patient is symptomatic," explains Dr. Ellsworth, who was not involved in the study. "This is often seen in patients performing clean intermittent catheterization and those with indwelling catheters in whom the urine may often show bacteria present. In this patient population this tendency to overdiagnose and treat can lead to the emergence of resistant bacteria."

In other words, treatment for certain amounts of bacteria is not always necessary. If the presence of bacteria is overtreated, that bacteria can become resistant to antibiotics and create a bigger problem down the road.

Dr. Trautner and her team looked at data on 339 cases of urinary bacteria. In 156 of these cases, patients were identified as having a urinary tract infection. In the other 183 cases, patients had the bacteria but no signs of infection.

Still, doctors inappropriately used antibiotics to treat 60 of the 183 cases without infection.

According to the authors, doctors are over-treating urinary bacteria with antibiotics, especially in patients with pyuria. They conclude, "Given the low incidence of infectious complications, efforts should be made to optimize the use of antibiotics in enterococcal bacteriuria."

The results of the study are published in the Archives of Internal Medicine

Reviewed by: 
Review Date: 
January 17, 2012
Last Updated:
February 1, 2012