About the project
Uncomplicated lower urinary tract infection (uUTI) is the most common bacterial infection in women and the second most common reason to prescribe antibiotics in primary care. Most uUTIs are self-limiting, but they are commonly treated with antibiotics as this gives quick symptom relief. Antibiotic use is the main contributor to antibiotic resistance, and to stop the rapid development it is crucial that we reduce unnecessary use of antibiotics. The overall aim of the thesis was to explore whether treatment with ibuprofen could be a safe and effective alternative to antibiotics (pivmecillinam) in women with uUTIs.
Outcomes
Vik and colleagues performed a randomised controlled trial comparing ibuprofen to pivmecillinam in the treatment of uUTI in non-pregnant women aged 18-60 years. A total of 383 women were randomly assigned to treatment with either ibuprofen (n=194, 181 analysed) or pivmecillinam (n=189, 178 analysed). By day 4, 39% of the patients in the ibuprofen group felt cured versus 74% in the pivmecillinam group. They found that ibuprofen was inferior to pivmecillinam in treating uUTIs. More than half of the women in the ibuprofen group recovered without antibiotics, but pyelonephritis occurred in 3.9%. No baseline information could significantly predict the need for antibiotic treatment. Given the current knowledge, a wait-and-see strategy can be recommended for women with symptoms of uUTI. Combined with a backup prescription of antibiotic treatment, symptom relief with 400 mg of ibuprofen up to three times a day seems safe to advice.
A retrospective comparison of three cohorts was performed to evaluate the bacteriological findings and resistance patterns in urine samples from women with uUTIs in Norway from 2000-2015. Pivmecillinam and nitrofurantoin are both good choices for empirical treatment of uUTIs. High levels of resistance challenge the rationale for using trimethoprim as a first-line agent.
Financing
The Research council of Norway
The Norwegian Research Fund for General Practice
Cooperation
University of Bergen (UiB)
Project start and finish
2013-2021