What are the downsides of delaying antibiotics for UTIs older people?

A study hot off the press in the BMJ has sought evaluate associations between different approaches to antibiotic treatment for urinary tract infection (UTIs) and severe adverse outcomes in elderly patients in primary care. 157 264 adults aged 65 years or older presenting to a general practitioner with at least one diagnosis of suspected or confirmed lower UTI from November 2007 to May 2015 were the study subjects, with bloodstream infection, hospital admission, and all cause mortality within 60 days after the index UTI diagnosis used as the endpoints. In the cases of 312 896 UTI episodes (157 264 unique patients), 7.2% (n=22 534) did not have antibiotics prescribed and 6.2% (n=19 292) had a delay in antibiotic prescribing. 1539 episodes of bloodstream infection (0.5%) were recorded within 60 days after the initial UTI, significantly higher among those not prescribed an antibiotic (2.9%; n=647) and those recorded as revisiting the general practitioner within seven days of the initial consultation for an antibiotic prescription, when compared with treated at the initial consultation (2.2% v 0.2%; P=0.001). After adjustment for covariates, patients were significantly more likely to experience a bloodstream infection in the deferred antibiotics group (adjusted odds ratio 7.12, 95% confidence interval 6.22 to 8.14) and no antibiotics group (8.08, 7.12 to 9.16) compared with the immediate antibiotics group. Hospital admissions were about twice as likely among people who received no antibiotics (27.0%) and deferred antibiotics (26.8%) compared with those prescribed immediate antibiotics (14.8%; P=0.001). The risk of all cause mortality was significantly higher with deferred antibiotics and no antibiotics than with immediate antibiotics at any time during the 60 days follow-up (adjusted hazard ratio 1.16, 95% confidence interval 1.06 to 1.27 and 2.18, 2.04 to 2.33, respectively). Men older than 85 years were particularly at risk. Are these practices actually harming people? Decide after reading the study in the BMJ here