Ibuprofen vs Antibiotics: Which Is Better for UTI?

Ibuprofen has been deemed inferior to the antibiotic pivmecillinam for the treatment of uncomplicated urinary tract infections (UTI) in women, according to new findings.

Researchers arrived at this conclusion following a study of 383 non-pregnant women aged 18 to 60 years across 16 sites in Norway, Sweden, and Denmark.
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Women were randomly assigned to treatment with either 600 mg ibuprofen (n = 189) or 200 mg pivmecillinam (n = 178) thrice daily for 3 days. Follow-up lasted 4 weeks.

The primary outcome was the proportion of patients who felt cured by day 4, and secondary outcomes were the proportion of patients requiring secondary antibiotic treatment and cases of polynephritis.

Results indicated that only 38.7% of ibuprofen-treated patients felt cured by day 4 compared with 73.6% of pivmecillinam-treated patients (adjusted risk difference: 35% in favor of pivmecillinam).

Furthermore, secondary endpoints were also generally found to favor pivmecillinam.

Over the course of follow-up, approximately 53% of ibuprofen-treated patients recovered without antibiotic treatment. However, 7 cases of pyelonephritis were reported in the ibuprofen group, of which 5 resulted in hospitalization and were classified as serious adverse events.

“Until we can identify those women who will develop complications, we cannot recommend ibuprofen alone as initial treatment to women with uncomplicated UTIs,” the researchers concluded.

—Christina Vogt

Reference:

Vik I, Bollestad M, Grude N, et al. Ibuprofen versus pivmecillinam for uncomplicated urinary tract infection in women—a double-blind, randomized non-inferiority trial [Published online May 15, 2018]. PLOS Med. https://doi.org/10.1371/journal.pmed.1002569