MedicalResearch.com Interview with:
Ingvild Vik MD
Doctoral Research Fellow
Department of General Practice
Institute of Health and Society – UiO
University of Oslo, Norway
MedicalResearch.com: What is the background for this study?
Response: Uncomplicated urinary tract infection (UTI) is the most common bacterial infection in women. It is painful and troublesome, and even though it is often self-limiting most women who see a doctor will be prescribed an antibiotic, as antibiotics provide quick symptom relief. Antibiotic resistance is a growing, serious public health problem. Antibiotic use is the main contributor to antibiotic resistance, and to stop the rapid development it is crucial that we reduce unnecessary use of antibiotics. Antibiotics can cause unpleasant and potentially severe side effects, so avoiding unnecessary use is also beneficial for the individual patient.
A small German trial published in 2010 by Bleidorn et al. suggested that ibuprofen was non-inferior to the antibiotic ciprofloxacin in achieving symptomatic cure in uncomplicated UTI. This inspired us to conduct a larger trial to compare the anti-inflammatory drug ibuprofen to antibiotics in the treatment of uncomplicated UTI.
MedicalResearch.com: What are the main findings?
Response: Ibuprofen, given instead of antibiotics to women with uncomplicated urinary UTI (cystitis), leads to longer duration of symptoms and more serious adverse events related to the spread of the primary infection.
We randomized 383 women to receiving treatment with either ibuprofen or antibiotics (pivmecillinam) three times a day for three days. 70 out of 181 patients receiving ibuprofen (39%) compared to 131 out of 178 receiving antibiotics (74%) recovered from symptoms within four days. More than half of the women receiving initial treatment with ibuprofen achieved clinical cure without antibiotic treatment. 83 patients (46%) did not get well and went to the doctor and received antibiotics, 12 patients (6.6%) experienced serious worsening of symptoms, and seven patients (3.9%) developed a kidney infection.
MedicalResearch.com: What should readers take away from your report?
Response: Ibuprofen cannot replace antibiotics in the treatment of uncomplicated UTI. Due to the fact that a few patients developed a more serious infection, we cannot recommend treatment with ibuprofen alone. However, a large proportion of the women did get well without antibiotic treatment, and we believe that for women with milder symptoms a wait-and-see strategy can be discussed. These women should be instructed to drink plenty of fluids and start taking antibiotics if they don’t recover within a few days or if their symptoms worsen.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We suspect that ibuprofen and other NSAIDs could facilitate an uncomplicated UTI developing into a more serious kidney infection. Placebo studies have shown that patients who were treated with placebo did not have more complications than the patients who received antibiotic treatment. In other words, for most women with mild to moderate symptoms of an uncomplicated UTI it is safe not to take antibiotics, but the condition is painful and we would like to offer these women a non-antibiotic treatment that provides symptom relief. Maybe paracetamol is a good option? It would be interesting to look into other treatment options in larger trials.
I have no disclosures.
Ingvild Vik, Marianne Bollestad, Nils Grude, Anders Bærheim, Eivind Damsgaard, Thomas Neumark, Lars Bjerrum, Gloria Cordoba, Inge Christoffer Olsen, Morten Lindbæk. Ibuprofen versus pivmecillinam for uncomplicated urinary tract infection in women—A double-blind, randomized non-inferiority trial. PLOS Medicine, 2018; 15 (5): e1002569 DOI: 10.1371/journal.pmed.1002569
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