NSAID vs Antibiotic for Symptomatic Urinary Tract Infection

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A total of 253 women with an uncomplicated lower UTI were enrolled.
A total of 253 women with an uncomplicated lower UTI were enrolled.

Nonsteroidal anti-inflammatory drugs (NSAIDs) were found to be inferior to antibiotics for symptom relief of uncomplicated urinary tract infection (UTI), according to findings from a newly published study appearing in the British Medical Journal (BMJ).

In this study, the researchers sought to investigate whether NSAIDs could provide symptomatic treatment for uncomplicated UTI in women, potentially reducing the need for antibiotic use in ambulatory care. They conducted a double-blind, randomized trial in 17 general practices in Switzerland; a total of 253 women with an uncomplicated lower UTI were enrolled.

One-hundred-and-thirty-three were randomly assigned to treatment with the NSAID diclofenac while 120 were assigned to the antibiotic norfloxacin. 

The primary endpoint of symptom resolution at day 3 was met by 54% (72/133) in the diclofenac group vs. 80% (96/120) in the norfloxacin group (risk difference 27%, 95% CI 15% to 38%, P=0.98 for non-inferiority, P<0.001 for superiority). The diclofenac group had a median symptom resolution time of 4 days, while symptoms in the norfloxacin group resolved on average at 2 days.

Additionally, 6 individuals (5%) in the diclofenac treatment group progressed to a pyelonephritis diagnosis (P=0.03) compared to none in the norfloxacin group.

The authors conclude that "symptomatic treatment is inferior to antibiotic treatment for women with uncomplicated lower UTI in an ambulatory setting, as it increases median symptom duration by two days and is likely to be associated with an increased risk of clinically diagnosed pyelonephritis." 

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