The Use of Antibiotics for Uncomplicated Urinary Tract Infections in Adult Women: Qualitative Findings From the SCOUT Trial

Berta Munné-Barellas,1 Ramon Monfà ,1– 3 Carl Llor,1,3,4 Ana Garcia-Sangenís,1– 3 Cristina Miranda-Jiménez,1 Rosa Morros,1– 3 Ana Moragas,3,5,6 Pablo Alvarez-Greciano,7 Alfonso Leiva,7 Mª Luisa Lozano-Del Hoyo,8 Maria Antonia Sánchez-Calavera,8 Jaime Marín-Cañada,9,10 Raquel Sánchez-Ruano10,11 1Fundació Institut Universitari per a la recerca a l’Atenció Primà ria de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; 2Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain; 3CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; 4Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark; 5CAP Jaume I, Institut Català de la Salut, Tarragona, Spain; 6University Rovira i Virgili, Tarragona, Spain; 7Primary Care Research Unit of Mallorca, Palma De Mallorca, Balearic Islands, Spain; 8Aragonese Health Services, Zaragoza, Spain; 9Villarejo de Salvanés Health Centre, Villarejo de Salvanés, Madrid, Spain; 10Unidad de investigación de la Gerencia Asistencial de Atención Primaria de, Madrid, Madrid, Spain; 11Research Network on Chronicity, Primary Care and Health Promotion. RICAPPS (RICORS), Madrid, SpainCorrespondence: Berta Munné-Barellas, Institut de Recerca en Atenció Primà ria Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587 attic, Barcelona, 08007, Spain, Email [email protected]: This paper focuses on women’s subjective experiences with UTIs and antibiotic use. Uncomplicated urinary tract infections (UTI) are among the most common infections treated in primary care, however, there is limited evidence regarding the experiences and their antibiotic treatment preferences.Objective: The aim of this study is to gather experiences, beliefs, and attitudes regarding the use of antibiotics and the participation in the clinical trial.Methods: This qualitative sub-study is part of the SCOUT project, which, through a clinical trial, aims to assess the effectiveness of four short antibiotic regimens (a single 3g dose of fosfomycin; 3g of fosfomycin for two days; 400mg of pivmecillinam for three days; and 100mg of nitrofurantoin for five days). A total of 68 semi-structured interviews were conducted in four regions of Spain (Catalonia N=19, Aragón N=19, Madrid N=15, and the Balearic Islands N=15). A purposive and theoretical sampling approach was employed. Participants were recruited after taking part in the clinical trial. Data collection took place between March and July 2024 and analysed using Thematic Analysis.Results: UTI did not cause excessive concern, except in cases where the antibiotic was ineffective or when participants had experienced multiple infections in the past. Fosfomycin was the most widely recognized antibiotic, and the two-dose regimen was generally well-regarded for being easy to take while also being more effective than the single-dose treatment. Longer regimens could cause some side effects, but in certain cases, they were perceived as more effective. Participation in the clinical trial was viewed positively, as it contributed to increasing overall knowledge about UTI and the antibiotics used to treat them, as well as ensuring closer monitoring of each specific case.Conclusion: This study gathers experiences related to UTI, antibiotic treatment regimens, and participation in the SCOUT clinical trial. It highlights the need to document the realities of UTI in order to improve future clinical trials.Keywords: urinary tract infection, women, patient satisfaction, antibiotic, qualitative research, clinical trial