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

Abstract

BackgroundAntibiotic 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). We explored clinicians’ and patients’ views on stopping antibiotics when better (SAWB) for urinary tract infections (UTIs), including comparisons with other acute infections.MethodWe recruited primary care clinicians, and patients with recent UTI experience, in England. We conducted remote one-to-one interviews with clinicians and patients, and one focus group with patients. Data were audio-recorded, transcribed, and analysed thematically.ResultsWe included 11 clinicians (seven general practitioners) and 19 patients (14 with experience of recurrent/chronic UTIs). All participants considered SAWB unfamiliar and contradictory to well-known advice to complete antibiotic courses, but were interested in the evidence for risk/benefit 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/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/complications). Participants stressed the need for unambiguous advice, and SAWB as part of shared decision making and personalised advice.ConclusionsPatients were less accepting of, whereas clinicians were more amenable to SAWB. 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’, and a clear indication of when exactly to stop antibiotics.

Nitrofurantoin: what is the evidence for current UK guidance?

“…We join others 50 , 51 , 61 in pointing out there may be ways of customizing duration of therapy to the patient’s response in primary care settings. Patients could be advised to contact the prescriber if symptoms resolve prior to finishing the course or else simply to stop treatment when they feel better.…”

Perception and views about individualising antibiotic duration for respiratory tract infections when patients feel better: a qualitative study with primary care professionals

“…However, during the writing of this article, we encountered a new publication by UK researchers addressing the reduction of antibiotic courses for urinary tract infections, based on an improved condition of patients, with a similar approach to our Open access study. 12 Similarly, most experts were against the perception that not completing or shortening antibiotic courses contributes to AMR. However, non-experts still consider that this statement is still true, a belief stemming from the notion, reinforced by public health messages, that incomplete eradication of pathogens leads to the resurgence of resistant infections.…”

Video consulting for GP trainees

“…Clinicians have reported that although many consultations can be safely managed by telephone, the remainder require in-person assessment, and both staff and patients have reported concerns about technological availability and skill (Greenhalgh et al., 2022). When used well, video consulting can overcome some of the drawbacks noted for telephone consulting, particularly around non-verbal communication and creating rapport (Donaghy et al., 2019; Payne and Clarke, 2023). For clinicians, these visual aspects may increase the quality and safety of consultations by allowing, for example, better checking of patient understanding, visual assessment of patients and better identification of safeguarding concerns (Atherton and Ziebland, 2016; Payne and Clarke, 2023).…”

“…When used well, video consulting can overcome some of the drawbacks noted for telephone consulting, particularly around non-verbal communication and creating rapport (Donaghy et al., 2019; Payne and Clarke, 2023). For clinicians, these visual aspects may increase the quality and safety of consultations by allowing, for example, better checking of patient understanding, visual assessment of patients and better identification of safeguarding concerns (Atherton and Ziebland, 2016; Payne and Clarke, 2023).…”