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Three Part Question

In [an female patient with an uncomplicated Urinary Tract Infection] are [NSAIDs better than Antibiotics] in [providing symptomatic relief]?

Clinical Scenario

A 44 year old female attends the Emergency Department with a two day history of worsening dysuria and urinary frequency. She is systemically well, but urinary dipstick testing confirms the presence of a urinary tract infection. The patient states that she does not want to take antibiotics and you wonder whether NSAIDs will provide adequate relief to the patient?

Search Strategy

Medline using the OVID interface 1946 to December week 4 2012
(Urinary tract infection.mp. or exp Urinary Tract Infections/) AND (nsaids.mp. or exp Anti-Inflammatory Agents, Non-Steroidal/) AND (antibiotics.mp. or exp Anti-Bacterial Agents/) No limits.

The Cochrane Library issue 12 of 12 2012

MeSH descriptor: (Urinary Tract Infections) explode all trees AND MeSH descriptor: (Anti-Inflammatory Agents, Non-Steroidal) explode all trees 2 records no relevancies.

Search Outcome

Sixteen papers were found in Medline. One paper was relevant (see table).

No relevant papers were found in the Cochrane search

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Bleidorn et al, 2010, Germany	80 women aged 18 to 85 years, presenting to General Practice with at least one of the main UTI symptoms and without any complicating factors.	Double-blind, randomized controlled pilot trial in 29 German general practices. Patients randomly assigned to receive either ibuprofen 3 × 400 mg oral or ciprofloxacin 2 × 250 mg (+1 placebo) oral, both for three days.	Symptom diary (score out of 12) at Day 0 (Ibuprofen Vs Ciprofloxacin)	Ibuprofen patients (5.3/12; SD 2.65), Ciprofloxacin patients (5.8/12; SD 2.54), (p-Value = 0.435) Non Significant difference	1. Possible Inclusion / Interpretation bias: 18% (29) of approached Primary Care practices took part in. Also, female-only study. 2. Subjective Inclusion criteria: (a) Dipstick Urinalysis optional (b) Patient-derived symptom scoring 3. Methodology: Not powered. 4. Subjective Follow-up: Telephone-based subjective assessment.
			Symptom diary (score out of 12) at Day 4 (Ibuprofen Vs Ciprofloxacin)	Ibuprofen patients (1/12; SD 1.42), Ciprofloxacin patients (1.3/12; SD 1.9), difference score points = -0.33 (95% CI (-1,13 to +0,47)), (p-Value = 0.406) Non Significant difference
			Total symptom resolution at day 4 (Ibuprofen Vs Ciprofloxacin)	Ibuprofen patients 21/36 (58.3%), Ciprofloxacin patients 17/33 (51.5%), p-value = 0.744, Non Statistical difference
			Total symptom resolution at day 7 (Ibuprofen Vs Ciprofloxacin)	Ibuprofen patients 27/36 (75%), Ciprofloxacin patients 20/33 (60.6%), p-value = 0.306, Non Statistical difference

Comment(s)

This study supports the assumption of the non-inferiority of ibuprofen when compared to ciprofloxacin in treating uncomplicated UTI. This suggests they are a viable option in the treatment of uncomplicated UTI. There is no statistically significant difference in outcomes between the two treatment groups. However, it is a small pilot study and results would need to be confirmed with further and larger trials.

Clinical Bottom Line

NSAID are a treatment option in the management of uncomplicated UTI. The potential benefits of this treatment warrant further research. However, this preliminary study does not suggest they are inferior or superior to pre-existing antibiotic therapy.

References

1. J Bleidorn, I Gágyor, M Kochen, K Wegscheider and E Hummers-Pradier Research article Symptomatic treatment (ibuprofen) or antibiotics (ciprofloxacin) for uncomplicated urinary tract infection? - Results of a randomized controlled pilot trial BMC Medicine 2010, 8:30