Re-examining advice to complete antibiotic courses: a qualitative study with clinicians and patients.
Borek A., Edwards G., Santillo M., Wanat M., Glogowska M., Butler C., Walker A., Hayward G., Tonkin-Crine S.
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). We explored clinicians' and patients' views on stopping antibiotics when better (SAWB) for urinary tract infections (UTIs), including comparisons with other acute infections. METHOD: We 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. RESULTS: We 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. CONCLUSIONS: Patients 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.