Ibuprofen not good for UTIs

With antibiotic resistance on the rise, non-steroidal anti-inflammatory drugs such as ibuprofen have been proposed by studies as an alternative treatment for uncomplicated urinary tract infection (UTI).

However, a new study from the University of Oslo, Norway, has found that ibuprofen — given instead of antibiotics to women with UTIs — leads to longer duration of symptoms and more serious adverse events related to the spread of the primary infection.

More than half of all women will experience an uncomplicated UTI during life, and most of these infections resolve without further complications. A short course of antibiotics is a widely accepted standard for the treatment of bacterial UTI, but antibiotic resistance is a growing, serious public health problem. Some prior studies have suggested that treatment with non-steroidal anti-inflammatory drugs such as ibuprofen may support recovery of a UTI, raising the possibility that antibiotic use could be reduced.

In the current study, the authors randomised 383 women from three Scandinavian countries with uncomplicated UTIs who received either standard treatment of antibiotics for three days or ibuprofen as a symptomatic treatment without an antimicrobial effect. Women’s symptoms, bacterial growth from urinary samples and the occurrence of adverse events including systemic infection or hospitalisation were monitored during the study.

The results showed that women assigned to receive ibuprofen without antibiotics took three days longer to get well on average. Seventy out of 181 patients receiving ibuprofen (39%) compared to 131 out of 178 receiving antibiotics (74%) recovered from symptoms by day four. Also, among women in the ibuprofen group, 12 (6.6%) developed a febrile urinary tract infection, with a smaller proportion (3.9%) developing a serious kidney infection, which did not occur in the antibiotics group.

Although more than half of the patients initially treated with ibuprofen got well without taking antibiotics suggesting that this approach could potentially reduce overall antimicrobial usage, the study concludes, in confirmation of other recently reported trials, that it is not safe to recommend ibuprofen instead of antibiotics in uncomplicated cystitis, due to the increased risk of developing a serious upper UTI.

“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 authors state in their conclusion.

The study has been published by PLOS Medicine.

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