CTU Bern

NSAIDs compared to antibiotics for the symptomatic treatment of UTI


Uncomplicated urinary tract infections UTI are a common reason for antibiotic prescription in ambulatory care even though they are often benign and self-limiting. Reducing antibiotic usage, especially in ambulatory care, is essential in the combat of increasing rates of antibiotic resistance.

The randomised, double blind trial, lead by the Institute of Infectious Diseases (University of Bern) and conducted in collaboration with CTU Bern, the Institute of Primary Health Care BIHAM and 17 general practitioners, investigated whether the symptomatic treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is non-inferior to antibiotics, thus offering an opportunity to reduce antibiotic use in ambulatory care.

253 women with uncomplicated lower urinary tract infection were enrolled. 133 were randomly assigned to treatment with the NSAID diclofenac while 120 were assigned to the antibiotic norfloxacin. 

Less women in the diclofenac group experienced a resolution of symptoms 3 days after treatment start (72/133 vs 96/120) and the median time until resolution of symptoms was increased (4 vs 2 days). Furthermore, 5% of the women (6) in the diclofenac group progressed to a pyelonephritis, whereas none did in the norfloxacin group. Over the course of the study, less women used antibiotics in the diclofenac group (82/133 vs 118/120).

The analysis of the data collected leads the researchers to conclude that "symptomatic treatment is inferior to antibiotic treatment for women with uncomplicated lower UTI in an ambulatory setting, as it increases median symptom duration by two days and is likely to be associated with an increased risk of clinically diagnosed pyelonephritis." Nevertheless, “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.”

Source: BMJ 2017;359:j4784