RT Journal Article
SR Electronic
T1 Re-examining advice to complete antibiotic courses: a qualitative study with clinicians and patients
JF BJGP Open
JO BJGP Open
FD Royal College of General Practitioners
SP BJGPO.2022.0170
DO 10.3399/BJGPO.2022.0170
VO 7
IS 2
A1 Borek, Aleksandra J
A1 Edwards, George
A1 Santillo, Marta
A1 Wanat, Marta
A1 Glogowska, Margaret
A1 Butler, Christopher C
A1 Walker, Ann Sarah
A1 Hayward, Gail
A1 Tonkin-Crine, Sarah
YR 2023
UL http://bjgpopen.org/content/7/2/BJGPO.2022.0170.abstract
AB Background Antibiotic treatment duration may be longer than sometimes needed. Stopping antibiotics early, rather than completing pre-set antibiotic courses, may help reduce unnecessary exposure to antibiotics and antimicrobial resistance (AMR).Aim To identify clinicians' and patients' views on stopping antibiotics when better (SAWB) for urinary tract infections (UTIs), and to explore comparisons with other acute infections.Design & setting An exploratory qualitative study with general practice clinicians and patients in England.Method Primary care clinicians and patients who had recent UTI experience were recruited in England. Remote one-to-one interviews with clinicians and patients, and one focus group with patients, were conducted. Data were audiorecorded, transcribed, and analysed thematically.Results Eleven clinicians (seven GPs) and 19 patients (14 with experience of recurrent and/or chronic UTIs) were included. All participants considered SAWB unfamiliar and contradictory to well-known advice to complete antibiotic courses, but were interested in the evidence for risks and benefits of SAWB. Clinicians were amenable if evidence and guidelines supported it, whereas patients were more averse because of concerns about the risk of UTI recurrence and/or complications and AMR. Participants viewed SAWB as potentially more appropriate for longer antibiotic courses and other infections (with longer courses and lower risk of recurrence and/or complications). Participants stressed the need for unambiguous advice and SAWB as part of shared decision making and personalised advice.Conclusion Patients were less accepting of SAWB, whereas clinicians were more amenable to it. Patients and clinicians require good evidence that this novel approach to self-determining antibiotic duration is safe and beneficial. If evidence based, SAWB should be offered with an explanation of why the advice differs from the ‘complete the course’ instruction, and a clear indication of when exactly to stop antibiotics should be given.