GPs felt confident with UTIs until the patient was a child, a man, older or recurrent

Design

Qualitative evidence synthesis with reflexive thematic analysis

Population

32 studies, 677 primary care practitioners

Primary outcome

Practitioners' views and experiences of managing urinary tract infection

Effect

Five themes; uncertainty concentrated in children, men, older adults and recurrent infection

This qualitative evidence synthesis in the British Journal of General Practice brought together 32 studies reporting on 677 primary care practitioners internationally, searched to June 2024. The included studies were judged high quality.

Five themes emerged. Practitioners felt confident with straightforward infection, but that confidence fell away with what the authors call 'patient X': children, men, older patients and those with recurrent infection. Practitioners described weighing antibiotic benefit against harm and resistance, working inside an overstretched system, and managing mismatched expectations, with the clinician-patient relationship carrying much of the weight.

The practical reading is that the uncertainty is predictable. It clusters in a few groups, and that is where local pathways, clear thresholds for urine culture and follow-up, and safety-netting advice do most good.

• Send a urine culture before treating suspected UTI in men, children, pregnant women and recurrent cases.
• Have a written safety-net plan for older patients with possible UTI, including when to recheck.
• Agree a practice pathway for recurrent UTI so decisions do not depend on who the patient sees.
• Discuss antibiotic benefit and harm openly; patients' expectations shape these consultations.

Why it matters

It names exactly where routine UTI care becomes difficult, which is where practice pathways should focus.

Don't overread it

Qualitative work describes clinicians' experience; it does not show which management approach gives better outcomes.

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