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Abstract Background Among older adults with delirium and positive urinalysis, antibiotic treatment for urinary tract infection is common practice, but unsupported by literature or guidelines. We sought to: i) determine the rate of antibiotic treatment and the proportion of asymptomatic patients (other than delirium) in this patient population, and ii) examine the effect of antibiotic treatment on delirium resolution and adverse outcomes. Methods A health record review was conducted at a tertiary academic centre from January to December 2020. Inclusion criteria were age ≥ 65, positive delirium screening assessment, positive urinalysis, and admission to general medical units. Outcomes included rates of antibiotic treatment, delirium on day 7 of admission, and 30-day adverse outcomes. We compared delirium and adverse outcome rates in antibiotic-treated vs. non-treated groups. We conducted subgroup analyses among asymptomatic patients. Results We included 150 patients (57% female, mean age 85.4 years). Antibiotics were given to 86%. The asymptomatic subgroup (delirium without urinary symptoms or fever) comprised 38% and antibiotic treatment rate in this subgroup was 68%. There was no significant difference in delirium rate on day 7 between antibiotic-treated vs. non-treated groups, (entire cohort RR 0.94 [0.41–2.16] and asymptomatic subgroup RR 0.69 [0.22–2.15]) or in 30-day adverse outcomes. Conclusions Older adults with delirium and positive urinalysis in general medical inpatient units were frequently treated with antibiotics – often despite the absence of urinary or other infectious symptoms. We failed to find evidence that antibiotic treatment in this population is associated with delirium resolution on day 7 of admission.

BackgroundSince the legalization of medical cannabis in Canada in 2013, prescription of cannabis for medical purposes has become commonplace and a multibillion dollar industry has formed. Much of the media coverage surrounding medical cannabis has been positive in nature, leading to Canadians potentially underestimating the adverse effects of medical cannabis use. In recent years, there has been a large increase in clinic websites advertising the use of medical cannabis for health indications. However, little is known about the quality of the evidence used by these clinic websites to describe the effectiveness of cannabis used for medical purposes. ObjectiveWe aimed to identify the indications for medical cannabis reported by cannabis clinics in Ontario, Canada, and the evidence these clinics cited to support cannabis prescription. MethodsWe conducted a cross-sectional web search to identify all cannabis clinic websites within Ontario, Canada, that had physician involvement and identified their primary purpose as cannabis prescription. Two reviewers independently searched these websites to identify all medical indications for which cannabis was promoted and reviewed and critically appraised all studies cited using the Oxford Centre for Evidence-Based Medicine Levels of Evidence rubric. ResultsA total of 29 clinics were identified, promoting cannabis for 20 different medical indications including migraines, insomnia, and fibromyalgia. There were 235 unique studies cited on these websites to support the effectiveness of cannabis for these indications. A high proportion (36/235, 15.3%) of the studies were identified to be at the lowest level of evidence (level 5). Only 4 clinic websites included any mention of harms associated with cannabis. ConclusionsCannabis clinic websites generally promote cannabis use as medically effective but cite low-quality evidence to support these claims and rarely discuss harms. The recommendation of cannabis as a general therapeutic for many indications unsupported by high-quality evidence is potentially misleading for medical practitioners and patients. This disparity should be carefully evaluated in context of the specific medical indication and an individualized patient risk assessment. Our work illustrates the need to increase the quality of research performed on the medical effects of cannabis.