When is it appropriate to take an antibiotic? That’s not an easy question to answer…even for doctors. Antibiotics can kill the bacteria that cause a variety of illnesses, but overuse of these drugs can lead to antibiotic resistance—in which the bugs being targeted become stronger than the medicine.

As this thorny question continues to be investigated in the US and elsewhere, researchers in the UK have identified a scenario in which prompt antibiotic use appears to be life-saving. Their results have been published in The BMJ

Study details: To better understand when antibiotics should be prescribed—and for whom—researchers from the Imperial College London crunched the data from 157,264 patients over age 65 who’d had a suspected or confirmed urinary tract infection (UTI). The patients were divided into three groups—those who had been given an immediate prescription for antibiotics…a delayed prescription (by up to seven days)…or no prescription at all.

Results: Compared with those who received an immediate antibiotic, adults who received a delayed prescription for the drug or no antibiotic at all were eight times more likely to develop sepsis, in which the body’s response to an infection can lead to tissue damage, organ failure and even death.

Additionally, people who got a delayed antibiotic or no antibiotic had roughly twice the rate of hospital admissions (27%) compared with those who got immediate treatment with the medication (15%).

Among those at greatest danger: Older men—especially those over age 85.

UTIs are among the most frequently diagnosed bacterial infections in adults over age 65. These infections, often called “bladder infections,” are frequently caused by E. coli bacteria and characterized by a relentless urge to urinate, burning pain and cloudy, pungent urine.

Caveat: The study authors noted that their results found an association but do not indicate that the delayed use (or no use) of antibiotics caused sepsis or death…and that the patients may have had other health conditions that contributed to their outcomes.

“Although antibiotic prescribing must be controlled to help combat the increasing problem of antibiotic resistance, our study suggests early use of antibiotics in elderly patients with UTIs is the safest approach,” said Paul Aylin, MBChB, senior author of the research and professor of epidemiology and public health, Imperial College London.

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