Acute uncomplicated urinary tract infections (UTIs) are common, however, treatment is not optimal. Few studies on antibiotic use for specific diagnoses have been done in XXX. Information is sparce about prescribing patterns in the region.Outpatient management of urinary tract infections by medical officers in XXX.The Aga Khan University hospital has 16 outpatient clinics in XXX run by medical-officers. A baseline assessment of evaluation and treatment of suspected UTI was performed from medical records. A medical-officer from each clinic was recruited with eight randomised to control vs. feedback groups. Both groups were given a multimodal educational session (CME) including locally adapted UTI guidelines and emphasis on problems identified in the baseline assessment. Each record was scored using a scoring system that was developed for the study according to adequacy of history, physical examination, clinical diagnosis matching recorded data, diagnostic workup and treatment. Three audits were done for both groups: baseline (audit 1), post-CME (audit 2), and a final audit, which was after feedback for the feedback group (audit 3). Primary analysis assessed overall guideline adherence in feedback group versus the CME only group.Overall scores in both groups showed significant improvement after the CME in comparison to baseline and for each group, the scores in most domains also improved. However, audit 3 showed persistence of the gains attained after the CME but no additional benefit from the feedback. Some deficiencies included lack of workup of possible STI and excess use of non-UTI laboratory tests such as Complete Blood Count, stool culture and H. pylori Ag. After the CME, the use of nitrofurantoin rose from only 4% to 8% and cephalosporin use increased from 49 to 67%, accompanied by a drop in quinolone use.This study is one of the few in XXX to study the effect of A&F on physician adherence to UTI guidelines for doctors trained at the medical officer level.This study has demonstrated the challenges in persuading physicians to use nitrofurantoin, the drug of choice for UTI treatment. The CME led to modest improvements in patient care in the categories of history taking, treatment and investigations.