Abx vs chance improvement in cognition in senior w UTI @ vasc dementia

Post date: 2021-06-15 17:40:55

What are the odds a senior with vascular dementia and chronic bladder outlet obstruction (high PVR) would *randomly* show *significant* improvements in cognition on days 3-5 of an antibiotic for a UTI?

Say the antibiotic was a broad spectrum one that hasn't worked super well in the past but is safer viz a viz risk of exacerbating long QT. I was told by a pharmacist that sometimes if it's the wrong antibiotic, improvements show up initially but then recede. That's what I have seen.

Say cognition has decreased any time there was an infection, and returned with treatment (by that antibiotic or one more targeted to culture results.)

Basically I fucking know that (certain) antibiotics make a difference (I log symptoms and effects religiously), and some doctors just won't treat because they're concerned with resistance even though the BMJ published an article demonstrating that elderly people tend to get bloodstream infections when they're not treated for UTIs (here).

Side note if an elderly person who's carrying 300 ml around has very high leukocyte esterase and pink goddamn pee and more than baseline confusion and no sign of other infection, I am inclined to call it a UTI, even if there isn't a culture (at that particular lab, on that particular day) or nitrates.

Say I'm wrong (I super don't think so but say I am). What else could explain MUCH improved cognition on days 3-5 of probably the wrong antibiotic? Is it possible that antibiotics could have some salutary effect on vascular dementia?

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