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The increasing prevalence of Clostridium difficile infection (CDI) has prompted many hospitals in the UK to recommend the use of narrow-spectrum antibiotics targeted at the likely bacteria at the clinical site of infection instead of broad-spectrum antibiotics. An underpinning requirement of such a strategy is the need to make an accurate diagnosis. In elderly patients, diagnosis of urinary tract infection can be challenging due to the frequent presence of respiratory signs and difficulties in the collection of urine specimens. This leads to the use of broad-spectrum antibiotics. Clinicians should attempt to make an accurate diagnosis of respiratory and urinary infections, as this will be crucial in the choice of the appropriate narrow-spectrum antibiotics.