Re-examining advice to complete antibiotic courses: a qualitative study with clinicians and patients.
antibiotic course
antimicrobial stewardship
communicable diseases
drug resistance, microbial
primary health care
qualitative research
Journal
BJGP open
ISSN: 2398-3795
Titre abrégé: BJGP Open
Pays: England
ID NLM: 101713531
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
received:
05
12
2022
accepted:
18
12
2022
medline:
1
2
2023
pubmed:
1
2
2023
entrez:
31
1
2023
Statut:
epublish
Résumé
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). 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. An exploratory qualitative study with general practice clinicians and patients in England. 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. 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. 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.
Sections du résumé
BACKGROUND
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
OBJECTIVE
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
METHODS
An exploratory qualitative study with general practice clinicians and patients in England.
METHOD
METHODS
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 36720563
pii: BJGPO.2022.0170
doi: 10.3399/BJGPO.2022.0170
pmc: PMC10354400
pii:
doi:
Types de publication
Journal Article
Langues
eng
Informations de copyright
Copyright © 2023, The Authors.
Références
S Afr Med J. 2015 Apr 06;105(5):325
pubmed: 26242647
Lancet. 1999 Sep 11;354(9182):943-5
pubmed: 10489971
Br J Gen Pract. 2006 Sep;56(530):686-92
pubmed: 16954001
Neurourol Urodyn. 2022 Mar;41(3):724-739
pubmed: 35114012
Clin Infect Dis. 2017 Aug 01;65(3):371-382
pubmed: 28369247
BMC Fam Pract. 2021 Jan 23;22(1):25
pubmed: 33485324
BMJ. 2010 May 18;340:c2096
pubmed: 20483949
Acad Med. 2014 Sep;89(9):1245-51
pubmed: 24979285
NPJ Prim Care Respir Med. 2014 Jul 17;24:14026
pubmed: 25030621
Int J Gynaecol Obstet. 2022 Oct;159(1):56-64
pubmed: 34995367
BMJ. 2017 Jul 26;358:j3418
pubmed: 28747365
Br J Gen Pract. 2017 Dec;67(665):e830-e841
pubmed: 29158245
BMJ. 2019 Feb 27;364:l440
pubmed: 30814052
BMJ Glob Health. 2019 May 09;4(3):e001239
pubmed: 31179029
Br J Gen Pract. 2015 Oct;65(639):e702-7
pubmed: 26412847
Antibiotics (Basel). 2016 Aug 15;5(3):
pubmed: 27537922
J Antimicrob Chemother. 2016 Jan;71(1):27-33
pubmed: 26459555
BMJ. 2010 Feb 05;340:c279
pubmed: 20139217
J Hosp Med. 2018 Jan 25;13(5):361.362
pubmed: 29370317
Int J Clin Pract. 2019 Jul;73(7):e13360
pubmed: 31066959
Antimicrob Agents Chemother. 2018 Dec 21;63(1):
pubmed: 30397061
J Antimicrob Chemother. 2007 Jul;60(1):92-9
pubmed: 17540675
Br J Gen Pract. 2022 Mar 31;72(717):e252-e260
pubmed: 35314431
Health Expect. 2020 Oct;23(5):1250-1258
pubmed: 32666579