Journal of Community Nursing - page 92

92 JCN
2013,Vol 27, No 4
CONTINENCE
in residential facilities due to
elderly and vulnerable individuals
living in close proximity as well as
indiscriminate antibiotic prescribing
(McClean et al, 2011). UTIs in these
patients may, therefore, be harder
to treat. Nitrofurantoin may have an
advantage over trimethoprim in these
patients in terms of its continued low
incidence of resistance.
The administration of
nitrofurantoin, formulated as
a liquid, may ensure effective
treatment of uncomplicated UTIs in
these vulnerable patient populations,
as well as ensuring the appropriate
use of antibiotics to minimise future
resistance problems (commonly
known as ‘antibiotic stewardship’).
A recent European survey of
the treatment of UTIs in residential
facilities suggests that the volume of
nitrofurantoin prescribing is indeed
increasing in the institutionalised
elderly patient population (McClean
et al, 2011).
However, as nitrofurantoin is
contraindicated in the presence
of significant renal impairment,
particular care should be taken
when prescribing to elderly
patients at increased risk of toxicity
(SIGN, 2012).
When performing urine cultures
in elderly patients, community
nurses should consider the
following:
Do not send urine for culture in
asymptomatic elderly people with
positive dipstick tests
Only send urine for culture if
there are two or more signs of
infection (especially dysuria),
fever over 38
o
or new episodes of
incontinence
Do not treat asymptomatic
bacteriuria in the elderly as it is
very common (SIGN, 2012).
CONCLUSION
UTIs are commonly encountered
in women in the community, with
prevalence increasing with age.
Other risk factors include sexual
activity, institutionalisation, co-
morbid disease and catheterisation
(SIGN, 2012).
The diagnosis of UTIs should
always be based on the signs and
symptoms, although microbiological
testing may have a role in confirming
the diagnosis.
Guidance from the HPA (2010)
suggests considering narrow spectrum
antibiotics such as trimethoprim or
nitrofurantoin as first-line treatments in
in European nursing homes.
J
Antimicrob Chemother
66:
1609–16
McKinnell JA, Stollenwerk NS, Jung
CW, Miller LG (2011) Nitrofurantoin
compares favorably to recommended
agents as empirical treatment of
uncomplicated urinary tract infections
in a decision and cost analysis.
Mayo
Clin Proc
86(6):
480–88
NICE (2012)
Urinary Tract Infection
(lower) — women: evidence
. Available at:
_
infection_lower_women/evidence/
supporting_evidence/antibiotic_
treatment_for_non_pregnant_women/
trimethoprim_compared_with_
nitrofurantoin (accessed 22 August
2013)
NPC (2009)
Common Infections: Urinary
Tract Infection
. Available at:
.
npc.nhs.uk/therapeutics/common_
infections/uti/resources/dfc_common_
infect_uti.pdf (accessed 22 August,
2013)
SIGN (2012) Management of suspected
bacterial urinary tract infection in
adults: a national clinical guideline.
Available at:
sign88.pdf (accessed 22 August, 2013)
‘There may be high levels
of antibiotic resistance in
residential facilities due
to elderly and vulnerable
individuals living in close
proximity.’
uncomplicated UTIs. Both trimethoprim
and nitrofurantoin are available in liquid
formulations to enable treatment in a
range of patient groups, such as those
with swallowing difficulties.
Of all healthcare professionals,
community nurses are ideally placed
to advise clinicians about patients
with UTI symptoms, and the most
appropriate form of treatment for a
particular patient, as they regularly
see patients at home or in nursing/
residential homes.
JCN
This paper has been funded and
reviewed by the Amdipharm Mercury
Company Ltd
REFERENCES
Balakrishnan I, Hill V (2011) Dealing with
urinary tract infections.
Pharmaceutical J
287:
687–90
British Medical Journal Best Practice
(2013)
Urinary tract infections in women.
Available at:
.
com/best-practice/monograph/77.html
(accessed 22 August, 2013)
HPA (2010)
Diagnosis of UTI Quick Reference
Guide for Primary Care.
HPA, London
HPA/British Infection Association (2010)
Management of Infection Guidance for
Primary Care for Consultation and Local
Adaptation
. HPA, London
Mahaffey W (2006) Diagnosis, treatment
and management of urinary tract
infections in primary care.
Nurse
Prescribing
4(7):
282–87
McClean P, Hughes C, Tunney M, Goossens
H, Jans B (2011) Antimicrobial prescribing
KEY POINTS
UTIs are common in the
community and are more
prevalent in women, the
prevalence increasing with age.
Other risk factors include sexual
activity, institutionalisation,
co-morbid disease and
catheterisation.
The diagnosis of UTIs
should be based on the signs
and symptoms, although
microbiological testing may
have a role in confirming the
diagnosis.
Guidance from the HPA (2010)
suggests considering narrow
spectrum antibiotics such as
trimethoprim or nitrofurantoin
as first-line treatments in
uncomplicated UTIs.
Both trimethoprim and
nitrofurantoin are available in
liquid formulations to enable
treatment in a range of patient
groups, such as those with
swallowing difficulties.
1...,82,83,84,85,86,87,88,89,90,91 93,94,95,96,97,98,99,100,101,102,...116