Ibuprofen alone should not be recommended as an initial treatment for women with uncomplicated urinary tract infections (UTIs), researchers have said
The researchers set out to explore whether treatment with ibuprofen could be a safe and efficient alternative to antibiotics in women with uncomplicated UTIs. Between April 2013 and June 2016, they recruited 383 non-pregnant women with symptoms of uncomplicated UTIs who were randomised to receive a three-day treatment of either ibuprofen, or pivmecillinam — an antibiotic commonly used to treat UTIs in Scandinavia.
They found that it generally took longer for the patients in the ibuprofen group to get well. In the ibuprofen group, 39% of patients felt cured by day four compared with 74% in the antibiotic group.
More than 45% of patients in the ibuprofen group returned to their doctor within four weeks with persisting, worsening or new symptoms, and had one or more secondary treatments with antibiotics. This compared to just 11% in the antibiotic group.
Of those treated with ibuprofen, 12 patients (6.6%) developed a febrile UTI, which was defined as flank pain and self-reported fever, and a C-reactive protein level of ≤40mg/L. Of these patients, seven developed pyelonephritis, where the infection spreads to the kidneys and C-reactive protein levels rise to ≥40mg/l.
The authors said that reducing the use of antibiotics came at the cost of stronger symptom burden, longer duration of symptoms and more complications.
However, more than half of the women treated with ibuprofen achieved symptom resolution without any additional treatment, suggesting that initial treatment ibuprofen could reduce unnecessary use of antibiotics in this group.
But the authors said that until it is possible to identify which women need antibiotic treatment in order to prevent complications, ibuprofen alone cannot be recommended to women with uncomplicated UTIs.
 Vik I, Bollestad M, Grude N et al. Ibuprofen versus pivmecillinam for uncomplicated urinary tract infection in women — double-blind, randomized non-inferiority trial. PLOS Med 2018. doi: 10.1371/journal.pmed.1002569