Ibuprofen, given instead of antibiotics to women with uncomplicated urinary tract infection, (cystitis), leads to longer duration of symptoms and more serious adverse events related to the spread of the primary infection, according to a new study in PLOS Medicine by Ingvild Vik and colleagues from the University of Oslo, Norway.
More than half of all women will experience an uncomplicated urinary tract infection during life, and most of these infections resolve without further complications. A short course of antibiotics is a widely accepted standard for the treatment of bacterial urinary tract infection, but antibiotic resistance is a growing, serious public health problem. Some prior studies have suggested that treatment with non-steroidal anti-inflammatory drugs such as ibuprofen may support recovery of a urinary tract infection, raising the possibility that antibiotic use could be reduced.
In the current study, the authors randomized 383 women from 3 Scandinavian countries with uncomplicated urinary tract infections to received either standard treatment of antibiotics for 3 days, or ibuprofen as a symptomatic treatment without an antimicrobial effect. Women's symptoms, bacterial growth from urinary samples, and the occurrence of adverse events including systemic infection or hospitalization, were monitored during the study. The results showed that women assigned to receive ibuprofen without antibiotics took three days longer to get well on average. 70 out of 181 patients receiving ibuprofen (39%) compared to 131 out of 178 receiving antibiotics (74%) recovered from symptoms by day 4 (35% adjusted risk difference, 95% CI). Also, among women in the ibuprofen group, twelve (6.6%) developed a febrile urinary tract infection, with a smaller proportion (3.9%) developing a serious kidney infection which did not occur in the antibiotics group.
Although more than half of the patients initially treated with ibuprofen got well without taking antibiotics suggesting that this approach could potentially reduce overall antimicrobial usage, the study concludes, in confirmation of other recently reported trials, that it is not safe to recommend ibuprofen instead of antibiotics in uncomplicated cystitis, due to the increased risk of developing a serious upper urinary tract infection.
"Initial treatment with ibuprofen could reduce unnecessary use of antibiotics in this group. However, until we can identify those women in need of antibiotic treatment to prevent complications, we cannot recommend ibuprofen alone to women with uncomplicated UTIs," the authors state in their conclusion.
The study was mainly funded by the Research Council of Norway (https://www.forskningsradet.no/en/Home_page/1177315753906), project number: 228775. IV and MB received initial funding from the Norwegian Medical Association (http://legeforeningen.no/), AFU and AMFF research funds. IV received contributions from the National Centre for Emergency Primary Health Care (http://uni.no/en/uni-health/national-centre-for-emergency-primary-health-care/) and The Reference Centre for Detection of Antimicrobial Resistance (NORM) (https://unn.no/fag-og-forskning/norm-norsk-overvakingssystem-for-antibiotikaresistens-hos-mikrober). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
I have read the journal's policy and the authors of this manuscript have the following competing interests: ICO has received personal fees from Pfizer, Inc.; there are no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Vik I, Bollestad M, Grude N, Bærheim A, Damsgaard E, Neumark T, et al. (2018) Ibuprofen versus pivmecillinam for uncomplicated urinary tract infection in women--A double-blind, randomized non-inferiority trial. PLoS Med 15(5): e1002569. https://doi.org/10.1371/journal.pmed.1002569
Department of Emergency General Practice, Oslo Accident and Emergency Outpatient Clinic, Oslo, Norway
Antibiotic Centre of Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
Division of Medicine, Stavanger University Hospital, Stavanger, Norway
Department of Medical Microbiology, Vestfold Hospital Trust, Tønsberg, Norway
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
Bergen Accident and Emergency Department, Bergen City Council, Bergen, Norway
Primary Health Care and Planning Division, Kalmar County Council, Kalmar, Sweden
Section of General Practice and Research Unit of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
Research Support Services CTU, Oslo University Hospital, Oslo, Norway
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