In a new study of patients with bacteria in their urine, doctors prescribed antibiotics to one in three who had no symptoms and no evidence of a urinary tract infection.
"When the average physician sees a positive (for bacteria) urine culture, they automatically think of treating," said Dr Peter Gross, an infectious diseases specialist at Hackensack University Medical Center in New Jersey who was not involved in the new study.
Dr Gross said that many doctors are afraid of the consequences (including legal ones) if they decide not to treat bacteriuria and it does develop into something more serious. Others, he added, might equate a positive test for bacteria with a urinary tract infection, or UTI, without thinking about other options.
In the new study, researchers from the Michael E. DeBakey Veterans Affairs Medical Center and the MD Anderson Cancer Center in Houston, Texas analysed data on 339 episodes of enterococcal bacteriuria in late 2009 at those two enters.
Most patients were older and male
Based on information from the lab tests and notes on patient symptoms characteristic of a UTI, the researchers determined that 156 episodes were true infections, while 183 involved colonisation only.
In cases with UTI symptoms, doctors were almost 12 times more likely to prescribe antibiotics as in symptom-free cases, Dr Barbara Trautner, of the VA, and her colleagues reported January 9 in the Archives of Internal Medicine.
Still, 60 episodes out of the 183 without evidence of a UTI were treated with antibiotics, against guidelines from the Infectious Diseases Society of America. Only in specific circumstances, such as pregnancy, do guidelines recommend treating bacterial colonisation in symptom-free people using antibiotics.
Even hospitalised patients with Foley catheters, Dr Gross said, will probably clear any bacteria within a week after getting the catheter taken out -- without the help of antibiotics - if they don't have a full-on infection.
New side effects
Dr Trautner's team found few side effects associated with the antibiotics used in patients with or without a UTI. But that doesn't change the fact, they note, that using antibiotics unnecessarily contributes to drug resistance.
What's more, the most commonly used antibiotics in the study were the broad-spectrum quinolones, for which resistance is a particular concern with overuse. When it comes to using antibiotics, Dr Gross said, "I agree with, 'less is more.'"
(Reuters Health, Genevra Pittman, January 2012)