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
Meta-Analysis
. 2024 Dec 19;12(12):CD014762.
doi: 10.1002/14651858.CD014762.pub2.

Non-steroidal anti-inflammatory drugs for treating symptomatic uncomplicated urinary tract infections in non-pregnant adult women

Ashwin Sachdeva  1   2 , Bhavan Prasad Rai  3 , Rajan Veeratterapillay  3 , Christopher Harding  3 , Arjun Nambiar  3
Affiliations
Meta-Analysis

Non-steroidal anti-inflammatory drugs for treating symptomatic uncomplicated urinary tract infections in non-pregnant adult women

Ashwin Sachdeva et al. Cochrane Database Syst Rev. .

Abstract

Background: Almost half of all women will have at least one symptomatic urinary tract infection (UTI) in their lifetime. Although usually self-remitting, 74% of women contacting a health professional are prescribed an antibiotic, and in rare instances, they may progress to more severe infections. Therefore, the standard of care for the treatment of symptomatic uncomplicated UTIs is oral antibiotic therapy, which aims to achieve symptom resolution and prevent the development of complications such as pyelonephritis. Given that a number of UTIs are self-remitting, non-antibiotic treatments that may help reduce the severity or duration of symptoms or reduce the need for antibiotics may be of benefit.

Objectives: This review aims to investigate the benefits and risks associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of symptomatic uncomplicated UTIs in non-pregnant adult women.

Search methods: We searched the Cochrane Kidney and Transplant Register of Studies up to 18 November 2024 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal and ClinicalTrials.gov.

Selection criteria: We included all randomised controlled trials (RCTs) and quasi-RCTs looking at the effectiveness of NSAIDs in the treatment of symptomatic uncomplicated UTIs in non-pregnant adult women. The outcomes of interest were: 1) short-term resolution of symptoms (days 1 to 4); 2) medium-term resolution of symptoms (days 5 to 10); and 3) incidence of adverse events (including progression to sepsis or complicated UTI, hospitalisation or need for intravenous antibiotics, gastrointestinal complications, or death) up to 30 days from randomisation.

Data collection and analysis: Screening, abstract selection, and data extraction were carried out independently by two authors, and any disagreements were resolved by discussion with a third author. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) and 95% CI for continuous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Main results: Six studies (1646 randomised women) published between 2010 and 2019 met our inclusion criteria. The mean age ranged from 28 to 50 years; previous UTIs were reported in 7.2% to 77% of participants. There were five multicentre studies, and studies were carried out in Denmark, Germany, Korea, Norway, Sweden, Switzerland, and the UK. Overall, the risk of bias was low or unclear. Compared to antibiotics, NSAIDs probably result in less short-term resolution of symptoms (4 studies, 1144 participants: RR 0.67, 95% CI 0.49 to 0.91; I2 = 75%; moderate certainty) and may also result in less medium-term resolution of symptoms (4 studies, 1140 participants: RR 0.84, 95% CI 0.71 to 1.01; I2 = 78%; low certainty). NSAIDs probably make little or no difference to the number of adverse events by day 30 (4 studies, 1165 participants: RR 1.08, 95% CI 0.88 to 1.33; I2 = 64%; moderate certainty). NSAIDs may result in longer duration of symptoms (2 studies, 553 participants: MD 1.00 day, 95% CI 0.61 to 1.39; I2 = 0%; low certainty). NSAIDs may result in a lower proportion of women experiencing microbiological resolution by day 10 compared to antibiotics (2 studies, 322 participants: RR 0.76, 95% CI 0.68 to 0.85; I2 = 0%; low certainty) and probably result in more women using rescue antibiotic treatment by day 30 (4 studies, 1165 participants: RR 3.14, 95% CI 2.23 to 4.42; I2 = 49%; moderate certainty). Compared to placebo, NSAIDs may reduce the use of rescue antibiotic treatment (1 study, 183 participants: RR 0.56, 95% CI 0.36 to 0.87; low certainty evidence) but may make little or no difference to adverse events at day 30. Compared to the herbal product Uva-Ursi, NSAIDs may make little or no difference to adverse events by day 30.

Authors' conclusions: The use of NSAIDs for symptomatic management of uncomplicated UTIs probably results in less short-term resolution of symptoms and greater use of rescue antibiotics by day 30 compared to primary antibiotic treatment. Future studies should consider the various confounders such as degree of symptoms, microbiology, type and resistance patterns of bacteria involved and number of UTI episodes in the months prior to commencement of treatment.

Trial registration: ClinicalTrials.gov NCT01488955 NCT01039545 NCT01849926.

PubMed Disclaimer

Conflict of interest statement

In accordance with Cochrane's Commercial Sponsorship Policy, the following declarations apply for the three years before the publication date of this review.

  1. Ashwin Sachdeva: Speaker Honorarium from Ipsen, travel support from AIRAmatrix, and consultancy fees from Veracyte (none of which concern NSAIDs in patients with UTI).

  2. Arjun Nambiar has declared that they have no conflict of interest

  3. Bhavan Prasad Rai has declared that they have no conflict of interest

  4. Rajan Veeratterapillay has declared that they have no conflict of interest

  5. Christopher Harding: Allergan Consultant Speaker Honorarium, Medtronic Speaker Honorarium, Proctor Astellas Speaker Honorarium, Teleflex Medical (none of which concern NSAIDs in patients with UTI).

Update of

  • doi: 10.1002/14651858.CD014762

Similar articles

See all similar articles

Cited by

References

References to studies included in this review

Bleidorn 2010 {published data only}00470468
    1. Bleidorn J, Gagyor I, Kochen MM, Wegscheider K, Hummers-Pradier E. Symptomatic treatment (ibuprofen) or antibiotics (ciprofloxacin) for uncomplicated urinary tract infection?--results of a randomized controlled pilot trial. BMC Medicine 2010;8:30. [MEDLINE: ] - PMC - PubMed
    1. Gagyor I, Bleidorn J, Wegscheider K, Hummers-Pradier E, Kochen MM. Practices, patients and (im)perfect data--feasibility of a randomised controlled clinical drug trial in German general practices. Trials [Electronic Resource] 2011;12:91. [MEDLINE: ] - PMC - PubMed
Gagyor 2012 {published data only}
    1. Bleidorn J, Hummers-Pradier E, Schmiemann G, Wiese B, Gagyor I. Recurrent urinary tract infections and complications after symptomatic versus antibiotic treatment: follow-up of a randomised controlled trial. German Medical Science 2016;14:Doc01. [MEDLINE: ] - PMC - PubMed
    1. Gagyor I, Bleidorn J, Kochen MM, Schmiemann G, Wegscheider K, Hummers-Pradier E. Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial. BMJ 2015;351:h6544. [MEDLINE: ] - PMC - PubMed
    1. Gagyor I, Hummers-Pradier E, Kochen MM, Schmiemann G, Wegscheider K, Bleidorn J. Immediate versus conditional treatment of uncomplicated urinary tract infection - a randomized-controlled comparative effectiveness study in general practices. BMC Infectious Diseases 2012;12:146. [MEDLINE: ] - PMC - PubMed
    1. Gagyor I, Schmiemann G, Kochen MM, Hummers-Pradier E, Wegscheider K, Bleidorn J. Ibuprofen first and antibiotics if needed for women with uncomplicated UTI? A randomized, controlled comparative effectiveness study in German family practices [abstract]. International Journal of Antimicrobial Agents 2017;50(Suppl 2):S26‐7. [EMBASE: 622094435]
Ko 2018 {published data only}KCT0001876
    1. Ko K, Lee WK, Oh CY, Lee SH, Cho ST, Bang WJ, et al. Is a combination of antibiotics and non-steroidal anti-inflammatory drugs more beneficial than antibiotic monotherapy for the treatment of female acute uncomplicated cystitis? A randomized controlled pilot study. Urology Journal 2018;15(6):365-9. [MEDLINE: ] - PubMed
Kronenberg 2017 {published data only}
    1. Kronenberg A, Butikofer L, Odutayo A, Muhlemann K, da Costa BR, Battaglia M, et al. Symptomatic treatment of uncomplicated lower urinary tract infections in the ambulatory setting: randomised, double blind trial [Erratum in: BMJ. 2017 Nov 13;359:j5268. doi: 10.1136/bmj.j5268]. BMJ 2017;359:j4784. [MEDLINE: ] - PMC - PubMed
Moore 2019 {published data only}43397016
    1. Moore M, Trill J, Simpson C, Webley F, Radford M, Stanton L, et al. Uva-ursi extract and ibuprofen as alternative treatments for uncomplicated urinary tract infection in women (ATAFUTI): a factorial randomized trial. Clinical Microbiology & Infection 2019;25(8):973-80. [MEDLINE: ] - PubMed
    1. Trill J, Simpson C, Webley F, Radford M, Stanton L, Maishman T, et al. Uva-ursi extract and ibuprofen as alternative treatments of adult female urinary tract infection (ATAFUTI): study protocol for a randomised controlled trial. Trials [Electronic Resource] 2017;18(1):421. [MEDLINE: ] - PMC - PubMed
Vik 2018 {published data only}2012‐002776‐14
    1. Vik I, Bollestad M, Grude N, Baerheim A, Damsgaard E, Neumark T, et al. Ibuprofen versus pivmecillinam for uncomplicated urinary tract infection in women-A double-blind, randomized non-inferiority trial. PLoS Medicine / Public Library of Science 2018;15(5):e1002569. [MEDLINE: ] - PMC - PubMed
    1. Vik I, Bollestad M, Grude N, Baerheim A, Molstad S, Bjerrum L, et al. Ibuprofen versus mecillinam for uncomplicated cystitis--a randomized controlled trial study protocol. BMC Infectious Diseases 2014;14:693. [MEDLINE: ] - PMC - PubMed
    1. Vik I, Mdala I, Bollestad M, Cordoba GC, Bjerrum L, Neumark T, et al. Predicting the use of antibiotics after initial symptomatic treatment of an uncomplicated urinary tract infection: analyses performed after a randomised controlled trial. BMJ Open 2020;10(8):e035074. [MEDLINE: ] - PMC - PubMed

References to studies excluded from this review

ACTRN12616000410459 {published data only}12616000410459
    1. ACTRN12616000410459. Can recurrent UTIs in post-menopausal women be prevented with aspirin? [Prevention of recurrent urinary tract infections in post-menopausal women using a non-antibacterial approach; a randomised, double-blinded, crossover, placebo-controlled trial of aspirin]. https://anzctr.org.au/ACTRN12616000410459.aspx (first received 30 March 2016).
Drozdov 2013 {published data only}
    1. Drozdov D, Schwarz S, Kutz A, Grolimund E, Rast AC, Steiner D, et al. Procalcitonin and pyuria-based algorithm reduces antibiotic use in urinary tract infections: a randomized controlled trial. BMC Medicine 2015;13:104. [MEDLINE: ] - PMC - PubMed
    1. Drozdov D, Thomer A, Meili M, Schwarz S, Kouegbe RB, Regez K, et al. Procalcitonin, pyuria and proadrenomedullin in the management of urinary tract infections--'triple p in uti': study protocol for a randomized controlled trial. Trials [Electronic Resource] 2013;14:84. [MEDLINE: ] - PMC - PubMed
Gaygor 2021 {published data only}
    1. Gagyor I, Hummers E, Schmiemann G, Friede T, Pfeiffer S, Afshar K, et al. Herbal treatment with uva ursi extract versus fosfomycin in women with uncomplicated urinary tract infection in primary care: a randomized controlled trial. Clinical Microbiology & Infection 2021;27(10):1441-7. [PMID: ] - PubMed
Jamil 2016 {published data only}
    1. Jamil MN, Farooq U, Sultan B, Khan RM. Role of symptomatic treatment in comparison to antibiotics in uncomplicated urinary tract infections. Journal of Ayub Medical College, Abbottabad: JAMC 2016;28(4):734-7. [MEDLINE: ] - PubMed
Steurer 2018 {published data only}
    1. Steurer J. Acute, uncomplicated urinary tract infection: pivmecillinam significantly more effective than ibuprofen [Akuter, unkomplizierter Harnwegsinfekt: Pivmecillinam deutlich heilsamer als Ibuprofen]. Praxis 2018;107(19):1055-6. [MEDLINE: ] - PubMed

References to ongoing studies

ISCTRN88111427 {published data only}2016‐003442‐87
    1. Are antibiotics really necessary to treat urinary tract infections in women or can support be offered with pain relief? isrctn.com/ISRCTN88111427 2017.

Additional references

Barclay 2017
    1. Barclay J, Veeratterapillay R, Harding C. Non-antibiotic options for recurrent urinary tract infections in women. BMJ 2017;359:j5193. [DOI: 10.1136/bmj.j5193] [PMID: ] - DOI - PubMed
Bleidorn 2016
    1. Bleidorn J, Hummers-Pradier E, Schmiemann G, Wiese B, Gagyor I. Recurrent urinary tract infections and complications after symptomatic versus antibiotic treatment: follow-up of a randomised controlled trial. German Medical Science 2016;14:Doc01. [DOI: 10.3205/000228] [PMID: ] - DOI - PMC - PubMed
Bonkat 2023
    1. Bonkat G, Bartoletti R, Bruyère F, Cai T, Geerlings SE, Köves B, et al. EAU Guidelines on Urological Infections. Arnhem, The Netherlands: EAU Guidelines Office, 2023.
Butler 2015
    1. Butler CC, Hawking MK, Quigley A, McNulty CA. Incidence, severity, help seeking, and management of uncomplicated urinary tract infection: a population-based survey. British Journal of General Practice 2015;65(639):e702-7. [MEDLINE: ] - PMC - PubMed
Carey 2020
    1. Carey MR, Vaughn VM, Mann J, Townsend W, Chopra V, Patel PK. Is non-steroidal anti-inflammatory therapy non-inferior to antibiotic therapy in uncomplicated urinary tract infections: a systematic review. Journal of General Internal Medicine 2020;35(6):1821-9. [PMID: ] - PMC - PubMed
Colgan 2011
    1. Colgan R, Williams M. Diagnosis and treatment of acute uncomplicated cystitis. American Family Physician 2011;84(7):771-6. [MEDLINE: ] - PubMed
Czaja 2007
    1. Czaja CA, Scholes D, Hooton TM, Stamm WE. Population-based epidemiologic analysis of acute pyelonephritis. Clinical Infectious Diseases 2007;45(3):273-80. [MEDLINE: ] - PubMed
Elvers 1995
    1. Elvers KT, Wright SJ. Antibacterial activity of the anti-inflammatory compound ibuprofen. Letters in Applied Microbiology 1995;20(2):82-4. [MEDLINE: ] - PubMed
Farkas 1980
    1. Farkas A, Alajem D, Dekel S, Binderman I. Urinary prostaglandin E2 in acute bacterial cystitis. Journal of Urology 1980;124(4):455-7. [MEDLINE: ] - PubMed
Flores‐Mireles 2015
    1. Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature Reviews. Microbiology 2015;13(5):269-84. [MEDLINE: ] - PMC - PubMed
Foxman 2000
    1. Foxman B, Barlow R, D'Arcy H, Gillespie B, Sobel J. Urinary tract infection: self-reported incidence and associated costs. Annals of Epidemiology 2000;10(8):509-15. [MEDLINE: ] - PubMed
Foxman 2003
    1. Foxman B, Brown P. Epidemiology of urinary tract infections: transmission and risk factors, incidence, and costs. Infectious Disease Clinics of North America 2003;17(2):227-41. [MEDLINE: ] - PubMed
GRADE 2008
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924-6. [MEDLINE: ] - PMC - PubMed
GRADE 2011
    1. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology 2011;64(4):383-94. [MEDLINE: ] - PubMed
Harding 2022
    1. Harding C, Chadwick T, Homer T, Lecouturier J, Mossop H, Carnell S, et al. Methenamine hippurate compared with antibiotic prophylaxis to prevent recurrent urinary tract infections in women: the ALTAR non-inferiority RCT. Health Technology Assessment (Winchester, England) 2022;26(23):23. [DOI: 10.3310/QOIZ6538] [PMID: ] - DOI - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557-60. [MEDLINE: ] - PMC - PubMed
Higgins 2022
    1. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook.
Hooton 2018
    1. Hooton TM, Vecchio M, Iroz A, Tack I, Dornic Q, Seksek I, et al. Effect of increased daily water intake in premenopausal women with recurrent urinary tract infections: a randomized clinical trial. JAMA Internal Medicine 2018;178(11):1509-15. [DOI: 10.1001/jamainternmed.2018.4204] [PMID: ] - DOI - PMC - PubMed
Kausner 2022
    1. Kausner Y, Rover C, Heinz J, Hummers E, Debray TP, Hay AD, et al. Reducing antibiotic use in uncomplicated urinary tract infections in adult women: a systematic review and individual participant data meta-analysis. Clinical Microbiology & Infection 2022;28(12):1558-66. [DOI: 10.1016/j.cmi.2022.06.017] [PMID: ] - DOI - PubMed
Knottnerus 2013
    1. Knottnerus BJ, Geerlings SE, Moll van Charante EP, ter Riet G. Women with symptoms of uncomplicated urinary tract infection are often willing to delay antibiotic treatment: a prospective cohort study. BMC Family Practice 2013;14:71. [MEDLINE: ] - PMC - PubMed
Leydon 2010
    1. Leydon GM, Turner S, Smith H, Little P. Women’s views about management and cause of urinary tract infection: qualitative interview study. BMJ 2010;340:c279. [MEDLINE: ] - PMC - PubMed
Murray 1982
    1. Murray BE, Rensimer ER, DuPont HL. Emergence of high-level trimethoprim resistance in fecal Escherichia coli during oral administration of trimethoprim or trimethoprim-sulfamethoxazole. New England Journal of Medicine 1982;306(3):130-5. [DOI: 10.1056/NEJM198201213060302] [PMID: ] - DOI - PubMed
Naber 2011
    1. Naber KG, Wullt B, Wagenlehner FM. Antibiotic treatment of uncomplicated urinary tract infection in premenopausal women. International Journal of Antimicrobial Agents 2011;38 Suppl:21-35. [MEDLINE: ] - PubMed
Obad 2015
    1. Obad J, Suskovic J, Kos B. Antimicrobial activity of ibuprofen: new perspectives on an “old” non-antibiotic drug. European Journal of Pharmaceutical Sciences 2015;71:93-8. [MEDLINE: ] - PubMed
Ong Lopez 2021
    1. Ong Lopez AM, Tan CJ, Yabon AS 2nd, Masbang AN. Symptomatic treatment (using NSAIDS) versus antibiotics in uncomplicated lower urinary tract infection: a meta-analysis and systematic review of randomized controlled trials. BMC Infectious Diseases 2021;21(1):619. [PMID: ] - PMC - PubMed
Schunemann 2022a
    1. Schünemann HJ, Higgins JP, Vist GE, Glasziou P, Akl EA, Skoetz N, et al. Chapter 14: Completing ‘Summary of findings’ tables and grading the certainty of the evidence. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.1 (updated February 2022). Cochrane, 2022. www.training.cochrane.org/handbook.
Schunemann 2022b
    1. Schünemann HJ, Vist GE, Higgins JP, Santesso N, Deeks JJ, Glasziou P, et al. Chapter 15: Interpreting results and drawing conclusions. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook.
Shah 2018
    1. Shah PN, Marshall-Batty KR, Smolen JA, Tagaev JA, Chen Q, Rodesney CA, et al. Antimicrobial activity of ibuprofen against cystic fibrosis-associated gram-negative pathogens. Antimicrobial Agents & Chemotherapy 2018;62(3):e01574-17. [MEDLINE: ] - PMC - PubMed
Stamm 1991
    1. Stamm WE, McKevitt M, Roberts PL, White NJ. Natural history of recurrent urinary tract infections in women. Reviews of Infectious Diseases 1991;13(1):77-84. [MEDLINE: ] - PubMed
Whiteside 2019
    1. Whiteside SA, Dave S, Reid G, Burton JP. Ibuprofen lacks direct antimicrobial properties for the treatment of urinary tract infection isolates. Journal of Medical Microbiology 2019;68(8):1244-52. [MEDLINE: ] - PubMed
Williams 2023
    1. Williams G, Stothart CI, Hahn D, Stephens JH, Craig JC, Hodson EM. Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews 2023, Issue 4. Art. No: CD001321. [DOI: 10.1002/14651858.CD001321.pub7] - DOI - PMC - PubMed

References to other published versions of this review

Sachdeva 2021
    1. Sachdeva A , Nambiar A , Rai BP , Veeratterapillay R, Harding C. Non-steroidal anti-inflammatory drugs for treating symptomatic uncomplicated urinary tract infections in non-pregnant adult women. Cochrane Database of Systematic Reviews 2021, Issue 11. Art. No: CD014762. [DOI: 10.1002/14651858.CD014762] - DOI - PMC - PubMed

MeSH terms

Substances

Associated data

LinkOut - more resources