DOES TREATMENT OF ASYMPTOMATIC BACTERIURIA IN OLDER AMBULATORY WOMEN REDUCE SUBSEQUENT SYMPTOMS OF URINARY-TRACT INFECTION

OBJECTIVE: To determine whether treatment of asymptomatic bacteriuria in older ambulatory women affects the subsequent development of sympto ms of urinary tract infection. DESIGN: A controlled clinical trial. PA RTICIPANTS: Older women not having urinary catheters. MEASUREMENTS: Ur ine cultures every 6 months (the same organism at 10(5) colony-forming units or more per mL on two midstream urine specimens defined asympto matic bacteriuria) and questionnaire surveys for the new development o f symptoms of urinary tract infection (dysuria, frequency, urgency, lo w back pain with fever) 1, 3, and 6 months after the initial survey. R ESULTS: Of the 23 initally culture-positive participants receiving ant ibiotic treatment for asymptomatic bacteriuria, nine were culture posi tive at 6 months, which contrasts with 18 of 27 who received no treatm ent or placebo, P = .05. However, symptoms of urinary tract infection were more common in the antibiotic-treated group. CONCLUSION: Antibiot ic therapy effectively reduced the subsequent occurrence of positive u rine cultures, but symptoms were not reduced. Based on this study of m orbidity, previous studies failing to show any relation to mortality, and the cost and complications of antibiotic therapy in the older popu lation, treatment of asymptomatic bacteriuria in older women is contra indicated.