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Ibuprofen alone not recommended for uncomplicated UTIs
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Overuse of antibiotics is a major driver of antimicrobial resistance, and stewardship efforts often focus on reducing the number of antibiotics that are prescribed to patients. In 2010, results from a German pilot study suggested ibuprofen was noninferior to ciprofloxacin for the treatment of symptomatic uncomplicated urinary tract infections — hinting at an alternative treatment for one of the most common causes of antibiotic prescribing. However, researchers cautioned that the findings needed confirmation in further trials.
Now, results from a larger study in Scandinavia have shown that antibiotics are still the best treatment for uncomplicated urinary tract infections.
In a randomized, controlled, double-blind noninferiority trial among 383 patients with uncomplicated UTIs, Ingvild Vik, MD, a researcher at the University of Oslo, Norway, and colleagues found that ibuprofen was inferior to an antibiotic commonly used to treat UTIs in Scandinavia.
Between April 2013 and June 2016, Vik and colleagues randomly assigned patients from general practices in Denmark, Norway and Sweden to be treated with either 600 mg of ibuprofen (n = 194,181 analyzed) or 200 mg of pivmecillinam (n = 189,178 analyzed) three times a day for 3 days and recorded how many patients from each arm “felt cured” by day 4.
According to the researchers, 38.7% of the participants who received only ibuprofen felt cured at day 4 vs. 73.6% in the pivmecillinam group, for an adjusted risk difference of 35% (90% CI, 27%-43%) in favor of pivmecillinam.
UTIs are often self-limiting, and 53% of women in the ibuprofen-only arm recovered without receiving any antibiotics at all, Vik and colleagues reported. But it took patients in the ibuprofen arm an average of 3 days longer to get well, and nearly half of them returned within 4 weeks with symptoms of a UTI.
Moreover, 12 patients in the ibuprofen-only arm developed a febrile UTI, and seven of them developed pyelonephritis, Vik and colleagues reported. All of these patients were successfully treated with antibiotics.
Based on the results and the risk for serious upper urinary tract infection, the researchers said it is unsafe to recommend ibuprofen over antibiotics to treat uncomplicated UTIs.
“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,” they wrote. – by Gerard Gallagher
Disclosures: Vik reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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