- Design
- Qualitative evidence synthesis with reflexive thematic analysis
- Population
- 32 studies, 677 primary care practitioners
- Primary outcome
- Practitioner views and experiences of managing UTI
- Effect
- Uncertainty concentrated in children, men, older adults and recurrent UTI
A qualitative evidence synthesis in the British Journal of General Practice, published on 1 October 2026, pooled 32 studies involving 677 primary care practitioners worldwide. The included studies were judged of high quality.
Five themes emerged. Practitioners were confident with the typical UTI, until a less typical patient — a child, a man, an older adult or someone with recurrent infection — made the consultation feel complex. They described an overstretched system, the constant weighing of antibiotic benefit against harm, and the importance of the relationship with the patient when expectations conflicted.
The change it points to is practical. The groups that generate uncertainty are predictable, and each has a guideline answer: culture before treatment, longer courses in men, caution with asymptomatic bacteriuria in older adults, and a structured plan for recurrence. Having those pathways ready turns an improvised decision into a routine one.
- Keep a short practice protocol for UTI in children, men, older adults and recurrent infection.
- Do not treat asymptomatic bacteriuria in older adults, including those with confusion and no urinary symptoms.
- Send cultures for every atypical group before antibiotics.
- Agree a recurrence plan with patients who have repeated infections, including when to return.
- Use the consultation to set expectations about antibiotics before the prescription question arises.
Why it matters
The uncertainty is predictable, which means it can be planned for rather than met fresh in each short consultation.
Don't overread it
A synthesis of practitioner experiences — it does not test whether protocols improve prescribing or outcomes.
The statistics, in plain English
Qualitative syntheses combine themes from interview studies; they describe how clinicians think, not how often errors occur.
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