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Re-examining advice to complete antibiotic courses: a qualitative study with clinicians and patients

Borek, Aleksandra; Edwards, George; Santillo, Marta; Wanat, Marta; Glogowska, Margaret; Butler, Christopher C; Walker, Ann; ... Tonkin-Crine, Sarah; + view all (2023) Re-examining advice to complete antibiotic courses: a qualitative study with clinicians and patients. BJGP Open 10.3399/BJGPO.2022.0170. Green open access

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Abstract

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.

Type: Article
Title: Re-examining advice to complete antibiotic courses: a qualitative study with clinicians and patients
Open access status: An open access version is available from UCL Discovery
DOI: 10.3399/BJGPO.2022.0170
Publisher version: https://doi.org/10.3399/BJGPO.2022.0170
Language: English
Additional information: Copyright © 2023, The Authors This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)
Keywords: Antibiotic course, drug resistance, microbial, antimicrobial stewardship, communicable diseases, primary health care, qualitative research
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10162197
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