Factors facilitating or hindering the use of antibiotic-sparing treatment strategies in women with uncomplicated urinary tract infections: a scoping review.

Abstract

Purpose: Antibiotic-sparing treatment (ASPT) strategies, such as delayed prescribing and symptomatic treatment, are promising to reduce antimicrobial consumption (AMC) in patients with uncomplicated urinary tract infections (uUTI). The aim of this scoping review was to identify literature reporting on factors that may act as barriers and facilitators to the use of ASPT in order to improve implementation.

Methods: MEDLINE (Ovid), Embase, the Cochrane Database, Google Scholar, Proquest Dissertations and Theses, the Clinical Trials Gov Registry and the ICTRP WHO Registry were searched for evidence of health care professionals and/or patients exposed to ASPT in the context of uUTI. We included evidence published between 2000 and 2024, from high-income countries and in any language. Identified factors were grouped into themes and categorized as facilitators or barriers.

Results: A total of 6543 unique records were screened for eligibility and 108 records were included in the review. Most evidence was from original research (n = 50, 46.3%) or reviews (n = 46, 42.6%). We identified AMC, clinical outcomes, healthcare utilisation, and patient- or prescriber-related factors as main themes. The main facilitator was the expectation of reduced AMC, while prolonged symptom duration and increased risk of disease progression were identified as main barriers.

Conclusion: The clinical management of uUTIs is shaped by factors that can facilitate or hinder ASPT use. This scoping review identified key factors and provided a basis for future research in the area of patient-provider decision making for ASPT, with the ultimate goal to inform targeted interventions and promote wider implementation of ASPT.