View Full Version : [Infectious Diseases] Symptomatic UTI Treatment Allows Some to Skip Antibiotics

Thu 14th January '16, 1:31pm
Source: Symptomatic UTI Treatment Allows Some to Skip Antibiotics (http://www.medscape.com/viewarticle/856808?nlid=96467_1842&src=wnl_edit_medp_wir&uac=180112PN&spon=17&impID=953908&faf=1)

By Reuters Staff
January 07, 2016

NEW YORK (Reuters Health) - Most women with uncomplicated urinary tract infections (UTIs) who undergo symptomatic treatment with ibuprofen can recover without antibiotics, according to a new randomized trial.

However, women initially treated with ibuprofen were more likely to develop pyelonephritis than were those who received fosfomycin and also had a higher symptom burden, Dr. Ildiko Gagyor of University Medical Center Gottingen in Gottingen, Germany, and colleagues found.

"Initial symptomatic treatment is a possible approach to be discussed with women willing to avoid immediate antibiotics and to accept a somewhat higher burden of symptoms," the team writes in The BMJ, online December 23.

Uncomplicated UTIs account for one-quarter of antibiotics prescribed in general practice, Dr. Gagyor and colleagues note. "As urinary tract infection is often self-limiting, and less antibiotic prescribing lowers levels of antibiotic resistance, efforts should be made to reduce rates of prescription," they add.

The investigators conducted a pilot study in 79 women with UTIs comparing symptomatic treatment with antibiotics, which found ibuprofen was not inferior for symptom resolution. In the new study, they analyzed data from 484 women ages 18 to 65 years with UTIs and no risk factors for complications. The women were randomly assigned to receive a single 3-gram dose of fosfomycin or three 400 mg doses/day of ibuprofen for three days; if their symptoms were persistent, worsened, or recurred, they were prescribed antibiotic treatment.

The 243 women in the fosfomycin group received a total of 283 courses of antibiotics (including 34 additional courses for UTI and six prescribed for other reasons), while the 241 women in the ibuprofen group received 94 courses of antibiotics, including 81 courses for UTIs.

The rate reduction in antibiotic use was 66.5% for the ibuprofen group. However, the symptom burden was significantly higher for the ibuprofen group, and their symptoms lasted about a day longer.

Five women in the ibuprofen group developed pyelonephritis, versus one in the fosfomycin group. Rates of adverse events were similar in both groups.

"In our trial, lower antibiotic consumption was 'bought' at the expense of a higher burden of symptoms until day seven in the ibuprofen group, with an area under the curve ratio of 140%," the researchers write.

They conclude: "We have to reject the hypothesis of non-inferiority of initial symptomatic treatment, and we cannot generally recommend the ibuprofen first approach. This treatment option, however, can be discussed with women with mild to moderate symptoms in a shared decision-making approach or within a strategy of delayed prescription."

Women who had negative results on urine culture in the ibuprofen and fosfomycin groups had similar symptom burdens, and the women initially on ibuprofen had just 0.1 course of antibiotic per patient, Dr. Lars Bjerrum of the University of Copenhagen and Dr. Morten Lindbaek of the University of Oslo in Denmark note in an editorial accompanying the study.

"This indicates, perhaps not surprisingly, that urine culture can help to identify the individuals most likely to benefit from antibiotics," they write.

"In the study by Gagyor and colleagues, only a third of patients with uncomplicated UTI needed antibiotics during the four weeks of follow-up, so a strategy of delayed prescription for patients with light to moderate symptoms might also be a feasible strategy," the editorialists add. "We need trials of delayed prescriptions for UTI. Delayed prescribing has been shown to reduce antibiotic prescriptions for respiratory tract infections by 50-70%."

Dr. Gagyor did not respond to an interview request by press time.

SOURCE: Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial | The BMJ (http://bit.ly/1mBPP4I)

BMJ 2015.