Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun;35(6):1821-1829.
doi: 10.1007/s11606-020-05745-x. Epub 2020 Apr 8.

Is Non-Steroidal Anti-Inflammatory Therapy Non-Inferior to Antibiotic Therapy in Uncomplicated Urinary Tract Infections: a Systematic Review

Matthew R Carey  1 , Valerie M Vaughn  1   2   3   4 , Jason Mann  4 , Whitney Townsend  5 , Vineet Chopra  1   2   3   4 , Payal K Patel  6   7   8   9
Affiliations

Is Non-Steroidal Anti-Inflammatory Therapy Non-Inferior to Antibiotic Therapy in Uncomplicated Urinary Tract Infections: a Systematic Review

Matthew R Carey et al. J Gen Intern Med. 2020 Jun.

Abstract

Background: Amid growing antimicrobial resistance, there is an increasing focus on antibiotic stewardship efforts to reduce inappropriate antibiotic prescribing. In this context, novel approaches for treating infections without antibiotics are being explored. One such strategy is the use of non-steroidal anti-inflammatory drugs (NSAIDs) for uncomplicated urinary tract infections (UTIs). Therefore, we conducted a systematic review of randomized controlled trials to evaluate the rates of symptom resolution and infectious complications in adult women with uncomplicated UTIs treated with antibiotics versus NSAIDs.

Methods: We systematically searched PubMed, CINHAL, Scopus, Web of Science Core Collection, EMBASE, and ClinicalTrials.gov from inception until January 13, 2020, for randomized controlled trials comparing NSAIDs with antibiotics for treatment of uncomplicated UTIs in adult women. Studies comparing symptom resolution between groups were eligible. Two authors screened all studies independently and in duplicate; data were abstracted using a standardized template. Risk of bias was assessed using the Cochrane Collaboration tool.

Results: Five randomized trials that included 1309 women with uncomplicated UTI met inclusion criteria. Three studies (1130 patients) favored antibiotic therapy in terms of symptom resolution. Two studies (179 patients) found no difference between NSAIDs and antibiotics in terms of symptom resolution. Three studies reported rates of pyelonephritis, two of which found higher rates in patients treated with NSAIDs versus antibiotics. Between two studies that reported this outcome (747 patients), patients randomized to NSAIDs received fewer antibiotic prescriptions compared with those in the antibiotics group. Three studies were at low risk of bias, one had an unclear risk of bias, and one was at high risk of bias.

Discussion: For the outcomes of symptom resolution and complications in adult women with UTI, evidence favors antibiotics over NSAIDs.

Prospero: CRD42018114133.

Keywords: NSAIDs; antibiotic stewardship; antibiotics; systematic review; urinary tract infection.

PubMed Disclaimer

Conflict of interest statement

The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the official position of the Department of Veterans Affairs.

Figures

Fig. 1
Fig. 1
Flow diagram of study selection.
Fig. 2
Fig. 2
Comparison of relative risk of symptom resolution by day 4 post-randomization for patients treated with non-steroidal anti-inflammatory drugs (NSAIDs) versus antibiotics.
See this image and copyright information in PMC

Comment in

References

    1. Lundborg CS, Olsson E, Molstad S. Antibiotic prescribing in outpatients: a 1-week diagnosis-prescribing study in 5 counties in Sweden. Scand J Infect Dis. 2002;34(6):442–8. - PubMed
    1. Petersen I, Hayward AC. Antibacterial prescribing in primary care. J Antibicrob Chemother. 2007;60(Suppl 1):i43–47. - PubMed
    1. Nicolle LE. Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis. Urol Clin North Am. 2008;35(1):1–12. - PubMed
    1. Foxman B, Brown P. Epidemiology of urinary tract infections: transmission and risk factors, incidence, and costs. Infect Dis Clin North Am. 2003;17(2):227–41. - PubMed
    1. Hooton TM. Clinical practice: uncomplicated urinary tract infection. N Engl J Med. 2012;366(11):1028–37. - PubMed

Publication types

MeSH terms

Substances