Impact of a Pharmacist-Led Urinary Tract Infection Treatment Protocol in a Psychiatric Hospital Without Infectious Disease Support: A Before-After Study
Abstract
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.
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| Files | ||
| Issue | Vol 13, No 4 (Autumn 2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Urinary Tract Infection Treatment Protocol Pharmacist-Led Intervention Ciprofloxacin Stewardship Asymptomatic Bacteriuria Psychiatric Hospitals Antimicrobial Stewardship | ||
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