This qualitative evidence synthesis in the British Journal of General Practice pooled 32 qualitative studies of 677 primary care practitioners from several countries. The quality of the included studies was rated high on the CASP checklist.
Five themes emerged: practitioners felt confident with straightforward cases; that confidence fell when an atypical patient presented (children, men, older people or those with recurrent infections); they felt pressed by an overstretched system; they weighed up the benefits of antibiotics against their wider effects; and the relationship with the patient shaped decisions.
This is a description of experience and not of outcomes. It shows where the clinical risk and the prescribing uncertainty concentrate, which helps decide where a protocol, a point-of-care test or a safety-net plan would be most use.
- GPs were confident in uncomplicated UTI but uncertain with children, men, older patients and recurrent infections.
- Antibiotic decisions were framed as a balance of individual benefit against wider harm.
- Time pressure and system strain were reported as pushing decisions.
- Agree a written pathway for the atypical groups in your practice.
- The synthesis reports views, so it cannot say which approach gives better outcomes.
Why it matters
It locates where UTI management goes wrong in practice, and that is the atypical patient, not the typical one.
Don't overread it
This describes practitioner perceptions and not patient outcomes or the quality of prescribing.
The statistics, in plain English
A qualitative synthesis has no effect sizes. Its strength is that themes recur across many studies and settings, and its limit is that what practitioners say they do may differ from what they do.
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