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Urinary Tract Infections Management · Journal article
Journal of Pharmaceutical Care · August 15, 2026
Encouraging direction, but not yet definitive.
This before-after study in a single Iranian psychiatric hospital demonstrates that a pharmacist-led UTI treatment protocol substantially improved urine culture request rates, antibiotic selection accuracy, and dosing appropriateness compared to usual care. The findings support the feasibility and process-level benefit of pharmacist-led stewardship in resource-limited mental health settings, but do not establish clinical superiority or generalizability beyond this site.
Before-after study. Patients with urinary tract infection diagnosis in a psychiatric hospital setting; phase I and II enrolled consecutively over the six-month period.. Intervention: Mandatory pharmacist-led UTI treatment protocol based on IDSA and JAMA guidelines. Compared with: Usual care (treatment without pharmacist consultation). n = 94. Roozbeh Hospital, Tehran, Iran.
Urine culture request rates improved from 26.5% to 95% (P < 0.001) Correct antibiotic selection increased significantly (P = 0.004), with fosfomycin replacing ciprofloxacin High-dose errors decreased from 29.4% to 8.3% (P = 0.02)
Surrogate endpoints only (culture requests, prescribing quality); no clinical outcomes (symptom resolution, relapse, safety events) reported.
Clinicians and stewardship teams in psychiatric and resource-limited settings may consider adopting pharmacist-led UTI protocols to reduce inappropriate prescribing and overtreatment. However, this single-centre result does not yet establish clinical superiority over usual care or reduce adverse events; implementation should be accompanied by local outcome monitoring.
A single-centre before-after study with modest sample size and surrogate endpoints (prescribing quality, culture rates) shows meaningful improvements in antimicrobial stewardship practice, but lacks a concurrent control and hard clinical outcomes.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians and stewardship teams in psychiatric and resource-limited settings may consider adopting pharmacist-led UTI protocols to reduce inappropriate prescribing and overtreatment. However, this single-centre result does not yet establish clinical superiority over usual care or reduce adverse events; implementation should be accompanied by local outcome monitoring.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background: Urinary tract infections (UTIs) are often misdiagnosed and inappropriately treated in psychiatric hospitals, largely due to challenges in patient communication, polypharmacy, and limited access to infectious disease specialists. In a psychiatric hospital setting in Tehran, Iran, ciprofloxacin was frequently prescribed despite guideline warnings, leading to a pharmacist-led intervention aimed at improving antimicrobial stewardship. This study aimed to evaluate the effectiveness of implementing a standardized urinary tract infection (UTI) treatment protocol, designed and supervised by a clinical pharmacist, on improving diagnostic accuracy and antibiotic prescribing in a psychiatric hospital setting. Methods: This before–after study was conducted at Roozbeh Hospital over a six-month period. In phase one, urinary tract infection treatments were initiated without pharmacist consultation. In phase two, a mandatory pharmacist-led protocol was implemented based on the Infectious Diseases Society of America (IDSA) and Journal of the American Medical Association (JAMA) guidelines. Data on urine culture rates, antibiotic selection, dosage accuracy, and treatment appropriateness were compared across both phases. Results: A total of 94 patients were included — 34 in phase I and 60 in phase II. Urine culture request rates improved from 26.5% to 95% (P < 0.001), reflecting adherence to the new protocol rather than case complexity. Correct antibiotic selection increased significantly (P = 0.004), with fosfomycin replacing ciprofloxacin as the preferred agent. High-dose errors decreased from 29.4% to 8.3% (P = 0.02), and unnecessary treatment of asymptomatic bacteriuria declined from 23.5% to 2% (P < 0.01). Conclusion: Pharmacist-led interventions improved diagnostic precision and antibiotic use in this psychiatric setting, suggesting a critical role for clinical pharmacists in antimicrobial stewardship, particularly in resource-limited mental health facilities.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.