Feasibility of a placebo-controlled trial of antibiotics for possible urinary tract infection in care homes: a qualitative interview study

Background Diagnosis of suspected urinary tract infection (UTI) in care home residents is commonly based on vague non-localising symptoms (eg, confusion), potentially leading to innapropriate antibiotic prescription. The safety of withholding antibiotics in such cases could be addressed by a randomised-controlled trial (RCT), however this would require close monitoring of residents, and support from care home staff, clinicians, residents, and families.

Aim To explore the views of residential care/nursing home staff and clinicians on the feasibility and design of a potential RCT of antibiotics for suspected UTI in care home residents with no localising urinary symptoms.

Design & setting Qualitative interviews

Method Semi-structured interviews with 16 UK care home staff and 11 clinicians were thematically analysed.

Results Participants were broadly supportive of the proposed RCT. The safety of residents was a priority, and there was strong support for using the RESTORE2 assesement tool to monitor residents, but concerns about associated training requirements. Effective communication (with residents, families, and staff) was deemed essential, but carers were confident that residents and families would be supportive if the rationale was clearly explained and safety systems were robust. There were mixed views on a placebo-controlled design. The perceived additional burden was seen as a potential barrier, and the use of bank staff and the out-of-hours period were highlighted as potential risk areas.

Conclusion The support for this potential trial was encouraging. Future development will need to prioritise resident safety (especially in the out-of-hours period), effective communication, and minimising additional burden on staff to optimise recruitment.