February 11, 2016
Ibuprofen for Initial Treatment of Women with Uncomplicated DysuriaPaul S. Mueller, MD, MPH, FACP reviewing Gágyor I et al. BMJ 2015 Dec 23.
This strategy limits antibiotic use and late recurrence but prolongs symptoms.Women with suspected uncomplicated urinary tract infections (UTIs) are usually treated with antibiotics, even though
this condition is often self-limited. Indeed, although prior research has shown that placebo or delayed antibiotics (compared with immediate antibiotics) prolonged resolution of symptoms and bacterial clearance, no serious UTI-associated complications were observed in any treatment group (NEJM JW Infect Dis Apr 2010 and BMJ 2010; 340:199). German investigators determined whether managing symptoms of uncomplicated UTI with ibuprofen could lower the rate of antibiotic prescriptions safely in 500 women (age range, 18–65) with suspected UTIs that are uncomplicated (defined as dysuria or frequency/urgency without upper-tract signs).
Urine cultures were positive in 76% of enrollees. Women were randomized to oral fosfomycin (Monurol; 3 g once daily) or
ibuprofen (400 mg thrice daily) for 3 days (plus placebo dummies). In the ibuprofen group, 34% of patients ultimately received antibiotics for symptoms that persisted or worsened during 28-day follow-up. In the fosfomycin group, 100% of patients received the antibiotic initially, and 14% received second courses for UTIs during follow-up. Mean durations of symptoms were significantly longer in the ibuprofen group than in the fosfomycin group (5.6 vs. 4.6 days), but UTI relapses and complications (e.g., recurrent UTIs, early relapse, or worsening of symptoms, pyelonephritis) were similar in the two groups. Notably, recurrence of UTI at day 15 through 28 was significantly less common in the ibuprofen group than in the fosfomycin group (6% vs. 11%).
COMMENT
In this randomized trial, managing suspected uncomplicated UTIs with ibuprofen rather than fosfomycin lowered antibiotic use by two thirds but was associated with greater symptom burden. Although UTI relapses and complications were similar in both groups, the study likely was not powered to detect important clinical differences.
The study is not likely to persuade clinicians and patients — at least in the U.S. — to withhold antibiotic therapy when women present with classic symptoms suggesting lower-tract urinary infection. However, the findings could support withholding antibiotics and providing analgesia (not necessarily ibuprofen, but perhaps the urinary analgesic phenazopyridine) while awaiting culture results in selected cases. Examples might include women with known intolerance or contraindications to usual antibiotic choices and women with mild or atypical symptoms.
EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication
Consultant / advisory boardBoston Scientific (Patient Safety Advisory Board)
Editorial boardsMedical Knowledge Self-Assessment Program (MKSAP 17 General Internal Medicine Committee); MKSAP 17 General Internal Medicine (author/contributor)
Leadership positions in professional societiesAmerican Osler Society (Vice President)
CITATION(S):
Gágyor I et al.
Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: Randomised controlled trial. BMJ 2015 Dec 23; 351:h6544. (Δεν είναι ορατοί οι σύνδεσμοι (links).
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Θέμα: Σιπροφλοξασίνη ή Ιμπουπροφένη για ανεπιπλέκτες συμπτωματικές ουρολοιμώξεις ;! (Αναγνώστηκε 5245 φορές)
17 Μαρτίου 2015, 21:47:26