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NSAIDs less effective than antibiotics for UTI, study finds



NSAIDs are less effective than antibiotics for symptom control in uncomplicated UTI, a study has found.

Patients with uncomplicated UTIs taking NSAIDs instead of antibiotics were less likely to experience early symptom resolution and had an increased risk of pyelonephritis.

The study, carried out by researchers at the University of Bern, Switzerland, inlcuded just over 250 Swiss women who presented to their GP with symptoms of an acute UTI. About half of the women were prescribed diclofenac and half were prescribed norfloxacin.

Resolution of symptoms at day three was observed in 80% of the norfloxacin group, but only 54% of the diclofenac group. The women were given a rescue antibiotic, fosfomycin, to use after day three at their discretion if symptoms persisted, which was taken in the first three days by 41% of the women prescribed diclofenac and just 8% of the women taking norfloxacin.

There were also six cases of clinically diagnosed pyelonephritis in the diclofenac group, compared to none in the norfloxacin group.

The authors said in the paper: ‘Our results in women with uncomplicated lower UTI are well in line with the prolongation of symptoms observed with symptomatic treatment of these conditions. As many women in the diclofenac group resorted to antibiotic treatment in our trial, a strategy of selectively deferring rather than completely withholding antibiotic treatment may be preferable for uncomplicated lower UTI.

‘This can be achieved through a shared decision making process, during which clinicians inquire about their patients’ ideas and expectations about antibiotic treatment for uncomplicated UTI and also explore the option of delaying antibiotic use as a treatment strategy.’

BMJ 2017; available online 8th Novemer