Ibuprofen inferior to antibiotic for uncomplicated UTIs
By day four, more than one-third of patients receiving ibuprofen reported they felt cured compared to nearly three-quarters in the pivmecillinam group, and secondary endpoints also generally favored pivmecillinam.
Ibuprofen was inferior to an antibiotic for treating uncomplicated urinary tract infections (UTIs), a study found.
Researchers in Scandinavia conducted a randomized controlled trial to determine whether treatment with ibuprofen was noninferior to pivmecillinam (an extended-spectrum penicillin not available in the U.S.) in achieving symptomatic resolution by day four, with a noninferiority margin of 10%. They recruited nonpregnant adult women presenting with symptoms of uncomplicated UTI from 16 sites in a general practice setting from April 2013 to April 2016. The women were randomized 1:1 to either 600 mg of ibuprofen or 200 of mg pivmecillinam three times a day for three days.
The primary outcome was the proportion of patients who felt cured by day four, as assessed from a patient diary. Secondary outcomes included the proportion of patients in need of secondary treatment with antibiotics and cases of pyelonephritis. Results were published May 15 by PLOS Medicine.
A total of 383 women were randomly assigned to treatment with either ibuprofen (n=194; 181 analyzed) or pivmecillinam (n=189; 178 analyzed). By day four, 38.7% of the patients in the ibuprofen group reported they felt cured versus 73.6% in the pivmecillinam group. The adjusted risk difference was 35% (90% CI, 27% to 43%) in favor of pivmecillinam, which crossed the prespecified noninferiority margin.
Secondary endpoints also generally favored pivmecillinam. After four weeks of follow-up, 53% of patients in the ibuprofen group recovered without antibiotic treatment, while only 10% of women in the antibiotic group required secondary treatment with an antibiotic by that point. Seven cases of pyelonephritis occurred, all in the ibuprofen group, giving a number needed to harm of 26 (95% CI, 13 to 103). Five of these patients were hospitalized and classified as having serious adverse events; two recovered as outpatients.
While more than half of the women in the ibuprofen group recovered without antibiotics, the rate of pyelonephritis was problematic, researchers noted. “Until we can identify those women who will develop complications, we cannot recommend ibuprofen alone as initial treatment to women with uncomplicated UTIs,” they wrote.