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Diclofenac inferior to norfloxacin for symptomatic treatment of UTIs
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Although the NSAID diclofenac decreased antibiotic use among women with uncomplicated lower urinary tract infection, it increased the median duration of symptoms and elevated the risk for pyelonephritis, according to findings published in the BMJ.
“UTI is one of the most common bacterial infections in adults, affecting considerably more women than men. ... Antibiotic prescriptions for UTI account for 10% to 20% of all antibiotic prescriptions in ambulatory care and are second only to antibiotic prescriptions for respiratory tract infections,” Andreas Kronenberg, MD, from the Institute for Infectious Diseases at the University of Bern, Switzerland, and colleagues wrote. “Reducing antibiotic prescriptions for UTI could potentially decrease the risk of antibiotic resistance.”
Kronenberg and colleagues conducted a randomized, double-blind trial to determine if NSAIDs are noninferior to antibiotics for the resolution of symptoms in cases of uncomplicated lower UTI in women. The researchers enrolled 253 women with uncomplicated lower UTI from 17 general practices in Switzerland and randomly assigned them to receive treatment for symptoms of UTI with either the NSAID diclofenac (n = 133) or the antibiotic norfloxacin (n = 120).
Symptom resolution at day 3 — 72 hours after randomization and 12 hours after receiving the last study drug — was experienced by more women in the norfloxacin group than the diclofenac group (80% vs. 54%; risk difference = 27%; 95% CI, 15-38; P < .001 for superiority). Women receiving diclofenac had a median time until symptom resolution of 4 days, whereas those receiving norfloxacin had a median time of 2 days.
Use of antibiotics up to day 30 was observed in 62% of women in the diclofenac group and 98% of those in the norfloxacin group (risk difference = 37%; 95% CI, 28-46). Five percent of women receiving diclofenac and no women receiving norfloxacin were diagnosed with pyelonephritis.
“Symptomatic treatment is inferior to antibiotic treatment for women with uncomplicated lower UTI in an ambulatory setting, as it increases median symptom duration by 2 days and is likely to be associated with an increased risk of clinically diagnosed pyelonephritis,” the researchers wrote. “The observed clinically relevant reduction in antibiotic use, which would likely contribute directly to decreasing resistance rates in the affected population, suggests that alternative approaches of combining symptomatic treatment with deferred, selective antibiotic use should be developed and tested in future trials,” Kronenberg and colleagues concluded. – by Alaina Tedesco
- Reference:
- Kronenberg A, et al. BMJ. 2017;doi:10.1136/bmj.j4784.
Disclosures: Kronenberg reports receiving travel grant and meeting expenses from Gilead Sciences, Viofor and WHO. He also reports serving as an advisor to the Swiss Federal Office of Public Health. Please see study for all other authors’ relevant financial disclosures.