Oslo, Norway—In an effort to reduce overuse of antibiotics, clinicians have been urged to consider alternatives when treating some common conditions.

A new study published in PLOS Medicine points out, however, that treating cystitis with ibuprofen for control of pain and inflammation is not advisable.

University of Oslo–led researchers caution that avoiding antibiotics in uncomplicated urinary tract (UTI) infection in women appears to lead to longer duration of symptoms and more serious adverse events.

As it stands now, a short course of antibiotics is standard for the treatment of bacterial urinary tract infections, which afflict more than half of women at some point in life. With antibiotic resistance a growing public health crisis, some previous research has suggested that antibiotic use could be reduced if patients used nonsteroidal anti-inflammatory drugs such as ibuprofen.

To determine what effect that might have, study authors focused on a cohort of 383 women from three Scandinavian countries. All had uncomplicated UTIs and were randomized to received either standard treatment of antibiotics, pivmecillinam, for 3 days, or ibuprofen as a symptomatic treatment without an antimicrobial effect.

Researchers monitored the women’s symptoms, bacterial growth from urinary samples, and the occurrence of adverse events, including systemic infection or hospitalization, during the study.

Results indicate that some women assigned to receive ibuprofen without antibiotics took 3 days longer, on average, to recover; 70 out of 181 patients receiving ibuprofen (39%) compared to 131 out of 178 receiving antibiotics (74%) recovered from symptoms by Day four (35% adjusted risk difference, 95% CI).

Of the women in the ibuprofen group, 6.6% developed a febrile urinary tract infection, and 3.9% turned up with a serious kidney infection, which did not occur in the antibiotics group. In fact, with the cases of pyelonephritis in the ibuprofen group, the number needed to harm was calculated as 26 (95% CI 13 -103). Overall, five of these patients were hospitalized and classified as having serious adverse events; while two recovered as outpatients.

On one hand, study authors point out that more than half of the patients initially treated with ibuprofen recovered well without taking antibiotics, which suggests the approach could potentially reduce overall antimicrobial usage. Yet they caution against that, advising against recommending ibuprofen instead of antibiotics in uncomplicated cystitis because of 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 researchers conclude.

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