Kronenberg et al recently published their findings in the BMJ. They conducted a double-blind, randomised controlled trial investigating whether treating uncomplicated urinary tract infections (UTIs) symptomatically with a non-steroidal anti-inflammatory drug was non-inferior to antibiotic treatment.

As antibiotic use for UTIs accounts for between 10-20% of antibiotic prescriptions, they hypothesized that reducing antibiotic prescriptions could be a way of decreasing the risk of antibiotic resistance. A small pilot trial had already found that symptomatic management of UTI with ibuprofen might be non-inferior to treatment with ciprofloxacin.

This larger study randomised patients with symptoms suggestive of a UTI and a positive urine dipstick for either nitrites or leucocytes, to a three day course of either slow release diclofenac or norfloxacin. The pre-specified primary outcome was symptom resolution by day 3.

Fifty-four percent of those treated with diclofenac and 80% treated with norfloxacin had experienced symptom resolution by day 3. Five percent of patients in the diclofenac arm and none in the norfloxacin arm developed pyelonephritis. Diclofenac was inferior to norfloxacin for relieving symptoms of UTI, although it did reduce antibiotic use.

Read the full piece here.