Nav: Home

Randomized trial finds ibuprofen not a safe alternative to antibiotics for UTIs

May 15, 2018

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.
-end-
Research Article

Funding:

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.

Competing Interests:

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.

Citation:

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

Author Affiliations:

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

In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002569

PLOS

Related Antibiotics Articles:

Antibiotics promote resistance on experimental croplands
Canadian researchers have generated both novel and existing antibiotic resistance mechanisms on experimental farmland, by exposing the soil to specific antibiotics.
Why antibiotics fail
UCSB biologists correct a flaw in the way bacterial susceptibility to these drugs is tested.
Fungi have enormous potential for new antibiotics
Fungi are a potential goldmine for the production of pharmaceuticals.
Antibiotics can boost bacterial reproduction
The growth of bacteria can be stimulated by antibiotics, scientists at the University of Exeter have discovered.
Last-line antibiotics are failing
The ECDC's latest data on antimicrobial resistance and consumption shows that in 2015, antibiotic resistance continued to increase for most bacteria and antibiotics under surveillance.
Two antibiotics fight bacteria differently than thought
Two widely prescribed antibiotics -- chloramphenicol and linezolid -- may fight bacteria in a different way from what scientists and doctors thought for years, University of Illinois at Chicago researchers have found.
Preserving the power of antibiotics
News release describes efforts to address inappropriate antibiotic prescribing in emergency departments and urgent-care centers nationwide, which a JAMA study published this past May found rates as high as 50 percent for acute respiratory infections in US emergency departments.
Antibiotics could be cut by up to one-third, say dairy farmers
Nine in 10 dairy farmers participating in a new survey from the Royal Association of British Dairy Farmers (RADBF) say that the farming industry must take a proactive lead in the battle against antibiotic resistance.
Antibiotics may be inappropriate for uncomplicated diverticulitis
Antibiotics are advised in most guidelines on diverticulitis, which arises when one or more small pouches in the digestive tract become inflamed or infected.
New book on Antibiotics and Antibiotic Resistance from CSHLPress
'Antibiotics and Antibiotic Resistance' from CSHLPress examines the major classes of antibiotics, together with their modes of action and mechanisms of resistance.

Related Antibiotics Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Climate Crisis
There's no greater threat to humanity than climate change. What can we do to stop the worst consequences? This hour, TED speakers explore how we can save our planet and whether we can do it in time. Guests include climate activist Greta Thunberg, chemical engineer Jennifer Wilcox, research scientist Sean Davis, food innovator Bruce Friedrich, and psychologist Per Espen Stoknes.
Now Playing: Science for the People

#527 Honey I CRISPR'd the Kids
This week we're coming to you from Awesome Con in Washington, D.C. There, host Bethany Brookshire led a panel of three amazing guests to talk about the promise and perils of CRISPR, and what happens now that CRISPR babies have (maybe?) been born. Featuring science writer Tina Saey, molecular biologist Anne Simon, and bioethicist Alan Regenberg. A Nobel Prize winner argues banning CRISPR babies won’t work Geneticists push for a 5-year global ban on gene-edited babies A CRISPR spin-off causes unintended typos in DNA News of the first gene-edited babies ignited a firestorm The researcher who created CRISPR twins defends...