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GPs should consider ibuprofen over antibiotic in UTI, suggests study

GPs can consider offering an initial course of ibuprofen to women with uncomplicated urinary tract infection, instead of prescribing an antibiotic, researchers have claimed.

The German team found nearly two-thirds of women who were given ibuprofen to help ease the symptoms of a urinary tract infection (UTI) recovered without resorting to antibiotics.

The study, published in the BMJ, included 248 women with typical UTI symptoms, half of whom took ibuprofen three times a day for three days, while the other half took a daily dose of the antibiotic fosfomycin for three days.

Of the 241 women who took ibuprofen to start with, 156 (65%) recovered without subsequently needing antibiotic treatment during a month of follow-up, and, overall, the ibuprofen group used 65% fewer antibiotics than the fosfomycin group.

However, although symptoms mostly cleared up within a week in both groups, on average the women who took ibuprofen had worse symptoms than those who took the antibiotic initially. They also suffered more complications during follow-up – with five cases of pyelonephritis in the ibuprofen group compared with one in the fosfomycin.

The researchers concluded that they ‘cannot generally recommend’ giving ibuprofen, but that the approach ‘can be discussed with women with mild to moderate symptoms in a shared decision making approach or within a strategy of delayed prescription’.

The team added that this ‘has the potential to considerably reduce the number of antibiotic prescriptions for women with mild to moderate symptoms of urinary tract infections’.

Readers' comments (7)

  • John Glasspool

    Hmmm... pyelonephritis?? NO thanks.

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  • Vinci Ho

    It is about making that call on the verge of 'uncomplicated' UTI treading into the territory of pyelonephritis , five times more in ibuprofen group? If anyone of that died of sepsis , what's next?

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  • In my experience patient's don't accept simple analgesics for viral URTI's. Try telling them to take ibuprofen for an uncomplicated UTI and see your complaint's rise.

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  • This is useless research.
    Is ibuprofen any better than giving nothing at all?
    Where is the control group?
    It may well be that advising fluids and a wait and see approach works for 65% of people anyway.
    How effective are over the counter treatments?
    Basing any treatment decision on the information above would be daft, especially as the risk of pyelonephritis was 5 times higher and I have never heard of this antibiotic being used in the UK.

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  • The beauty of research is that it does not need to bring in anything new to science and this one looks like a sponsored one. Historically -

    'It (Fosfomycin) was licensed for UTI treatment in the UK some years ago but was not a commercial success and therefore the UK licence lapsed.
    •A urine specimen must have been examined by the laboratory
    •There must be a significant growth of a fosfomycin-sensitive organism in the urine sample
    •There must be no other suitable oral treatment alternative'
    Why fosfomycin in the first place and why is there no work about potential renal s/e of nsaid on a kidney with infection?

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  • Ibuprofen makes urine acidic hence bacteria fail to thrive.
    No better than cranberry juice I tell ya.

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  • i have seen too many young women developed pyelonephritis . i don't recommend cranberry juice or ibuprofen. treat them as you would like to be treated.

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