Health Literacy and Treatment Outcomes in Multidrug-Resistant Tuberculosis: A Systematic Review

Abstract

Introduction The prehospital setting is increasingly recognised as an opportunity to reduce delays in antibiotic administration for selected infections and traumatic injuries, and several Emergency Medical Services (EMS) have implemented prehospital antibiotic administration. However, existing reviews are limited to specific clinical conditions, and no comprehensive synthesis has mapped the breadth of evidence on prehospital antibiotic administration across key characteristics. This scoping review will map and characterise the nature and extent of the existing evidence on the administration of antibiotics in prehospital care by EMS. Inclusion criteria The review will consider evidence from any patient population receiving antibiotics during prehospital care delivered by EMS. This will include evidence on clinical indications, antibiotic regimens, clinical outcomes, EMS protocols and guidelines, provider category, and implementation practices, if care is delivered within an organised EMS system. There will be no restriction on geographical location, resource availability or healthcare systems. We will consider primary research, evidence syntheses and relevant grey literature appropriate to the review questions. Methods The Joanna Briggs Institute’s guidance for scoping reviews will be followed. A comprehensive search for published, unpublished, and grey literature will be conducted with no date or language restrictions. Electronic databases will include MEDLINE (PubMed), CINAHL (EBSCOhost), Web of Science, Scopus, and Cochrane Library. Grey literature sources will include ProQuest Dissertations & Theses Global, Web of Science Conference Proceedings Citation Index, and the World Health Organisation Institutional Repository for Information Sharing. Ongoing and unpublished studies will be identified via trial registries. Search results will be retrieved and deduplicated with EndNote 2025. Title/abstract, full-text screening and data extraction will be conducted independently by two reviewers on Rayyan. Any disagreements will be resolved through discussion or a third reviewer. The data will be summarised in accordance with the scoping review objective and presented in graphical and tabular formats, accompanied by narrative descriptions. Review Registration https://osf.io/haxz9