Improving Prophylactic Antibiotic use for Recurrent Urinary Tract Infection (IMPART): Mixed-methods study to address evidence gaps and develop a decision aid

Sanyaolu, Leigh ORCID: https://orcid.org/0000-0002-6762-6986 2025. Improving Prophylactic Antibiotic use for Recurrent Urinary Tract Infection (IMPART): Mixed-methods study to address evidence gaps and develop a decision aid. PhD Thesis, Cardiff University. Item availability restricted.

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Abstract

Urinary tract infections (UTIs) affect half of all women during their lifetime. They are frequently managed in primary care and can have substantial impacts on patients and healthcare. UTI recurrence occurs in between 24-44% of women and it’s estimated that 3% of women get recurrent UTIs (rUTIs). This is concerning since rUTIs result in frequent antibiotic exposure, an important driver of antimicrobial resistance (AMR). In view of the increasing global burden of AMR, it is important to reduce UTIs and antibiotic use, whilst increasing use of non-antibiotic prophylaxis. The aim was to address evidence gaps in rUTIs utilising mixed methods and integrate these findings, with existing knowledge, into a patient decision aid (PtDA) to improve shared decision-making (SDM) for rUTI prevention. Qualitative and quantitative systematic reviews demonstrated that rUTIs are a chronic condition with significant impacts on patients’ lives. Patients and healthcare professionals (HCPs) are concerned about antibiotic use, patients feel non-antibiotic options need further discussion and research with HCPs finding rUTIs challenging. Trials demonstrate prophylactic antibiotics and vaginal oestrogen are effective at reducing rUTI recurrence and methenamine has similar efficacy to prophylactic antibiotics. However, trials are limited by bias and limited non-antibiotic comparisons. Using population-based data, 6% of women have rUTIs and 1.7% use prophylactic antibiotics, with evidence of resistance prior to initiation. It is also estimated that prophylactic antibiotic use increases urine AMR risk by 7% and multidrug AMR by 8%. Interviews with women with rUTIs and HCPs demonstrate stigma associated with self-care discussions and that HCPs frequently discuss self-care with patients. Both felt that more information on non-antibiotic prevention is required, that a rUTI PtDA would be beneficial and HCPs find prophylactic antibiotic de prescribing challenging. These findings, and existing evidence, have been integrated into a prototype PtDA to support SDM for rUTI management in primary care.

Item Type:	Thesis (PhD)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Medicine
Date of First Compliant Deposit:	12 September 2025
Last Modified:	18 Sep 2025 11:52
URI:	https://orca.cardiff.ac.uk/id/eprint/181064

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