Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Primary Care
Published in: BMC Primary Care 1/2021

01-12-2021 | Pyelonephritis | Research article

Construction of a patient decision aid for the treatment of uncomplicated urinary tract infection in primary care

Authors: Yves-Marie Vincent, Adèle Frachon, Clotilde Buffeteau, Guillaume Conort

Published in: BMC Primary Care | Issue 1/2021

Login to get access

Abstract

Background

Uncomplicated urinary tract infection (uUTI) is very common among women in primary care. The risk of developing pyelonephritis remains low after uUTI, nonetheless, empiric antibiotic therapy is frequently prescribed for symptomatic purposes. This may lead to adverse effects and antibiotic resistance. Furthermore, patients may express the will to limit the use of antibiotics. Some European countries recommend discussing a delayed prescription with the patient and developing a shared decision. The aim of this study is to create a patient decision aid (PtDA) used in primary care settings to make a shared decision between practitioners and women about whether or not to treat uUTI with antibiotics.

Methods

We followed the steps recommended by the International Patient Decision Aids Standards, with a scoping phase, a design phase (including focus groups and literature review), and an alpha-testing phase. A steering group, made of patients and physicians, met throughout the study to develop a prototype PtDA.

Results

The information included in the PtDA is the definition of uUTI, information on the options, their benefits, risks, and consequences, based on a review of the literature. The results of the focus group made possible to determine the patient’s values and preferences to consider in decision-making, including: the discomfort felt, the impact on daily life, patients’ perceptions of antibiotics, and the position relative to the risk of adverse effect. The choices in presentation, organisation and design are the result of the work of the steering group, improved by feedback from alpha testing. We confirmed the need for shared decision-making and the equipoise in this situation.

Conclusions

We developed a PtDA to be used in primary care for sharing decision on the use of antibiotic in uUTI. It needs to be validated in a beta-testing phase, with complementary advice from peers, and then tested in a clinical study comparing its use with the systematic prescription approach.
Appendix
Available only for authorised users
Literature
1.
Hummers-Pradier E, Kochen MM. Urinary tract infections in adult general practice patients. Br J Gen Pract. 2002;52:752–61.PubMedPubMedCentral
2.
Foxman B, Barlow R, D’Arcy H, Gillespie B, Sobel JD. Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol. 2000;10:509–15.PubMedCrossRef
3.
Flower A, Bishop FL, Lewith G. How women manage recurrent urinary tract infections: an analysis of postings on a popular web forum. BMC Fam Pract. 2014;15:162.PubMedPubMedCentralCrossRef
4.
Butler CC, Hawking MK, Quigley A, McNulty CA. Incidence, severity, help seeking, and management of uncomplicated urinary tract infection: a population-based survey. Br J Gen Pract. 2015;65:e702–7.PubMedPubMedCentralCrossRef
5.
Christiaens TCM, De Meyere M, Verschraegen G, Peersman W, Heytens S, De Maeseneer JM. Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women. Br J Gen Pract. 2002;52:729–34.PubMedPubMedCentral
6.
Falagas ME, Kotsantis IK, Vouloumanou EK, Rafailidis PI. Antibiotics versus placebo in the treatment of women with uncomplicated cystitis: a meta-analysis of randomized controlled trials. J Inf Secur. 2009;58:91–102.
7.
Leydon GM, Turner S, Smith H, Little P. UTIS team. Women’s views about management and cause of urinary tract infection: qualitative interview study. BMJ. 2010;340:c279.PubMedPubMedCentralCrossRef
8.
9.
Gágyor I, Bleidorn J, Kochen MM, Schmiemann G, Wegscheider K, Hummers-Pradier E. Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial. BMJ. 2015;351:h6544.PubMedPubMedCentralCrossRef
10.
11.
Hooton TM. Clinical practice. Uncomplicated urinary tract infection. N Engl J Med. 2012;366:1028–37.PubMedCrossRef
12.
Malmros K, Huttner BD, McNulty C, Rodríguez-Baño J, Pulcini C, Tängdén T. Comparison of antibiotic treatment guidelines for urinary tract infections in 15 European countries: results of an online survey. Int J Antimicrob Agents. 2019;54:478–86.PubMedCrossRef
13.
Caron F, Galperine T, Flateau C, Azria R, Bonacorsi S, Bruyère F, et al. Practice guidelines for the management of adult community-acquired urinary tract infections. Med Mal Infect. 2018;48:327–58.PubMedCrossRef
14.
Butler CC, Francis N, Thomas-Jones E, Llor C, Bongard E, Moore M, et al. Variations in presentation, management, and patient outcomes of urinary tract infection: a prospective four-country primary care observational cohort study. Br J Gen Pract. 2017;67:e830–41.PubMedPubMedCentralCrossRef
15.
Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52:e103–20.PubMedCrossRef
16.
Rossignol L, Vaux S, Maugat S, Blake A, Barlier R, Heym B, et al. Incidence of urinary tract infections and antibiotic resistance in the outpatient setting: a cross-sectional study. Infection. 2017;45:33–40.PubMedCrossRef
17.
Malmartel A, Ghasarossian C. Epidemiology of urinary tract infections, bacterial species and resistances in primary care in France. Eur J Clin Microbiol Infect Dis. 2016;35:447–51.PubMedCrossRef
18.
Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010;340:c2096.PubMedCrossRef
19.
Kornfält Isberg H, Melander E, Hedin K, Mölstad S, Beckman A. Uncomplicated urinary tract infections in Swedish primary care; etiology, resistance and treatment. BMC Infect Dis. 2019;19:155.PubMedPubMedCentralCrossRef
20.
21.
22.
23.
24.
25.
van der Weijden T, Boivin A, Burgers J, Schünemann HJ, Elwyn G. Clinical practice guidelines and patient decision aids. An inevitable relationship. J Clin Epidemiol. 2012;65:584–9.PubMedCrossRef
26.
van Esch TEM, Brabers AEM, Hek K, van Dijk L, Verheij RA, de Jong JD. Does shared decision-making reduce antibiotic prescribing in primary care? J Antimicrob Chemother. 2018;73:3199–205.PubMedCrossRef
27.
28.
Coulter A, Stilwell D, Kryworuchko J, Mullen PD, Ng CJ, van der Weijden T. A systematic development process for patient decision aids. BMC Med Inform Decis Mak. 2013;13(Suppl 2):S2.PubMedPubMedCentralCrossRef
29.
30.
31.
32.
Sepucha KR, Abhyankar P, Hoffman AS, Bekker HL, LeBlanc A, Levin CA, et al. Standards for UNiversal reporting of patient decision aid evaluation studies: the development of SUNDAE checklist. BMJ Qual Saf. 2018;27:380–8.PubMedCrossRef
33.
34.
Elwyn G, O’Connor A, Stacey D, Volk R, Edwards A, Coulter A, et al. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ. 2006;333:417.PubMedPubMedCentralCrossRef
35.
Dubi J, Chappuis P, Darioli R. Treatment of urinary infection with a single dose of co-trimoxazole compared with a single dose of amoxicillin and a placebo. Schweiz Med Wochenschr. 1982;112:90–2.PubMed
36.
Brooks D, Garrett G, Hollihead R. Sulphadimidine, co-trimoxazole, and a placebo in the management of symptomatic urinary tract infection in general practice. J R Coll Gen Pract. 1972;22:695–703.PubMedPubMedCentral
37.
Asbach HW. Single dose oral administration of cefixime 400mg in the treatment of acute uncomplicated cystitis and gonorrhoea. Drugs. 1991;42(Suppl 4):10–3.PubMedCrossRef
38.
Ferry SA, Holm SE, Stenlund H, Lundholm R, Monsen TJ. Clinical and bacteriological outcome of different doses and duration of pivmecillinam compared with placebo therapy of uncomplicated lower urinary tract infection in women: the LUTIW project. Scand J Prim Health Care. 2007;25:49–57.PubMedPubMedCentralCrossRef
39.
Bleidorn J, Gágyor I, Kochen MM, Wegscheider K, Hummers-Pradier E. Symptomatic treatment (ibuprofen) or antibiotics (ciprofloxacin) for uncomplicated urinary tract infection? - results of a randomized controlled pilot trial. BMC Med. 2010;8:30.PubMedPubMedCentralCrossRef
40.
Kronenberg A, Bütikofer L, Odutayo A, Mühlemann K, da Costa BR, Battaglia M, et al. Symptomatic treatment of uncomplicated lower urinary tract infections in the ambulatory setting: randomised, double blind trial. BMJ. 2017;359:j4784.PubMedPubMedCentralCrossRef
41.
Ronald AR, Pattullo ALS. The natural history of urinary infection in adults. Med Clin N Am. 1991;75:299–312.PubMedCrossRef
42.
Hooton TM. The current management strategies for community-acquired urinary tract infection. Infect Dis Clin N Am. 2003;17:303–32.CrossRef
43.
Little P, Merriman R, Turner S, Rumsby K, Warner G, Lowes JA, et al. Presentation, pattern, and natural course of severe symptoms, and role of antibiotics and antibiotic resistance among patients presenting with suspected uncomplicated urinary tract infection in primary care: observational study. BMJ. 2010;340:b5633.PubMedPubMedCentralCrossRef
44.
45.
Huttner A, Kowalczyk A, Turjeman A, Babich T, Brossier C, Eliakim-Raz N, et al. Effect of 5-day Nitrofurantoin vs single-dose Fosfomycin on clinical resolution of uncomplicated lower urinary tract infection in women. JAMA. 2018;319:1781–9.PubMedPubMedCentralCrossRef
46.
Moore M, Trill J, Simpson C, Webley F, Radford M, Stanton L, et al. Uva-ursi extract and ibuprofen as alternative treatments for uncomplicated urinary tract infection in women (ATAFUTI): a factorial randomized trial. Clin Microbiol Infect. 2019;25:973–80.PubMedCrossRef
47.
Wagenlehner FM, Abramov-Sommariva D, Höller M, Steindl H, Naber KG. Non-antibiotic herbal therapy (BNO 1045) versus antibiotic therapy (Fosfomycin Trometamol) for the treatment of acute lower uncomplicated urinary tract infections in women: a double-blind, parallel-group, randomized, multicentre. Non-Inferiority Phase III Trial Urologia Internationalis. 2018;101:327–36.PubMedCrossRef
48.
Mantzorou M, Giaginis C. Cranberry consumption against urinary tract infections: clinical Stateof- the-art and future perspectives. CPB. 2019;19:1049–63.CrossRef
49.
50.
Guerville P, Régi V, Ventelou V. Les pratiques en médecine générale dans cinq régions. Direction de la recherche, des études, de l’évaluation et des statistiques Etudes et Résultats; 2009. p. 8.
51.
Tausch AP, Menold N. Methodological aspects of focus groups in Health Research: results of qualitative interviews with focus group moderators. Global Qualitative Nursing Research. 2016;3:233339361663046.CrossRef
52.
53.
Loh A, Simon D, Wills CE, Kriston L, Niebling W, Härter M. The effects of a shared decision-making intervention in primary care of depression: a cluster-randomized controlled trial. Patient Educ Couns. 2007;67:324–32.PubMedCrossRef
54.
Little P, Moore MV, Turner S, Rumsby K, Warner G, Lowes JA, et al. Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. BMJ. 2010;340:c199.PubMedPubMedCentralCrossRef
Metadata
Title
Construction of a patient decision aid for the treatment of uncomplicated urinary tract infection in primary care
Authors
Yves-Marie Vincent
Adèle Frachon
Clotilde Buffeteau
Guillaume Conort
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2021
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-021-01374-3

Other articles of this Issue 1/2021

BMC Primary Care 1/2021 Go to the issue

Research

Adapting the definition of multimorbidity – development of a locality-based consensus for selecting included Long Term Conditions

Research article

Prevalence, aetiologies and prognosis of the symptom cough in primary care: a systematic review and meta-analysis

Research article

Implementation outcomes of Humanwide: integrated precision health in team-based family practice primary care

Research

The receipt of information by family physicians about their patient’s emergency department visits: a record linkage study of electronic medical records to health administrative data

Research article

Long term clinical outcomes of patients with ischemic stroke in primary care – a 9-year retrospective study

Research article

Development of an eHealth programme for self-management of persistent physical symptoms: a qualitative study on user needs in general practice