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Ibuprofen not a safe alternative to antibiotics for uncomplicated UTIs

Strategy could cut antibiotic use, but increases risk of fever and developing a serious upper UTI

Louise Prime

Wednesday, 16 May 2018

Ibuprofen alone should not be used as initial treatment for women with uncomplicated urinary tract infections (UTIs) because this strategy raises their risk of developing a febrile urinary tract infection or a serious kidney infection compared with antibiotic treatment, general practice-based research has shown. The authors of the study*, published in PLOS Medicine, said women given ibuprofen took much longer to recover, on average, than those given antibiotics – and were also nearly five times as likely to return to their doctor within four weeks.

The researchers, from Norway, Sweden and Denmark, said that most patients with uncomplicated UTIs are prescribed antibiotics, even though the problem is usually self-limiting. Because of concerns about growing antibiotic resistance, it has been suggested that women with a UTI might be advised instead to take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, thus reducing antibiotic use. They set up their study to compare ibuprofen with pivmecillinam for uncomplicated UTI; the main outcome was whether or not ibuprofen was non-inferior to pivmecillinam in achieving symptomatic cure by day four.

They randomised non-pregnant women aged 18-60 years, who had presented in general practice with symptoms of uncomplicated UTI, to treatment with either 600mg ibuprofen (194 women) or 200mg pivmecillinam (189 women) three times a day for three days. The women, their doctors and study personnel were all blinded to treatment allocation.

They reported that by day four, 38.7% of the patients in the ibuprofen group felt cured compared with 73.6% in the pivmecillinam group (an adjusted risk difference, with 90% confidence interval, of 35% in favour of pivmecillinam); it took three days longer for the patients in the ibuprofen group to get well.

After four weeks’ follow-up, 53% of women in the ibuprofen group had recovered without antibiotic treatment. But there were seven cases of pyelonephritis, all in the ibuprofen group, of whom five women were hospitalised and two recovered as outpatients.

The study authors added that 46% of the patients in the ibuprofen group returned to the doctor within four weeks with persisting, worsening, or new symptoms, but only 10% of the patients in the pivmecillinam group came back for a second consultation.

They concluded that, as some other recent trials have found, it is not safe to recommend ibuprofen instead of antibiotics in uncomplicated cystitis, because of the increased risk of developing a serious upper urinary tract infection. They said: “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.”


*Vik I, Bollestad M, Grude N, et al. Ibuprofen versus pivmecillinam for uncomplicated urinary tract infection in women – A double-blind, randomized non-inferiority trial. PLoS Med 2018; 15(5): e1002569.

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